Crawling-induced floor dust resuspension affects the microbiota of the infant breathing zone.

BACKGROUND: Floor dust is commonly used for microbial determinations in epidemiological studies to estimate early-life indoor microbial exposures. Resuspension of floor dust and its impact on infant microbial exposure is, however, little explored. The aim of our study was to investigate how floor dust resuspension induced by an infant's crawling motion and an adult walking affects infant inhalation exposure to microbes. RESULTS: We conducted controlled chamber experiments with a simplified mechanical crawling infant robot and an adult volunteer walking over carpeted flooring. We applied bacterial 16S rRNA gene sequencing and quantitative PCR to monitor the infant breathing zone microbial content and compared that to the adult breathing zone and the carpet dust as the source. During crawling, fungal and bacterial levels were, on average, 8- to 21-fold higher in the infant breathing zone compared to measurements from the adult breathing zone. During walking experiments, the increase in microbial levels in the infant breathing zone was far less pronounced. The correlation in rank orders of microbial levels in the carpet dust and the corresponding infant breathing zone sample varied between different microbial groups but was mostly moderate. The relative abundance of bacterial taxa was characteristically distinct in carpet dust and infant and adult breathing zones during the infant crawling experiments. Bacterial diversity in carpet dust and the infant breathing zone did not correlate significantly. CONCLUSIONS: The microbiota in the infant breathing zone differ in absolute quantitative and compositional terms from that of the adult breathing zone and of floor dust. Crawling induces resuspension of floor dust from carpeted flooring, creating a concentrated and localized cloud of microbial content around the infant. Thus, the microbial exposure of infants following dust resuspension is difficult to predict based on common house dust or bulk air measurements. Improved approaches for the assessment of infant microbial exposure, such as sampling at the infant breathing zone level, are needed.

Infant and Adult Inhalation Exposure to Resuspended Biological Particulate Matter.

Human-induced resuspension of floor dust is a dynamic process that can serve as a major indoor source of biological particulate matter (bioPM). Inhalation exposure to the microbial and allergenic content of indoor dust is associated with adverse and protective health effects. This study evaluates infant and adult inhalation exposures and respiratory tract deposited dose rates of resuspended bioPM from carpets. Chamber experiments were conducted with a robotic crawling infant and an adult performing a walking sequence. Breathing zone (BZ) size distributions of resuspended fluorescent biological aerosol particles (FBAPs), a bioPM proxy, were monitored in real-time. FBAP exposures were highly transient during periods of locomotion. Both crawling and walking delivered a significant number of resuspended FBAPs to the BZ, with concentrations ranging from 0.5 to 2 cm-3 (mass range: ∼50 to 600 µg/m3). Infants and adults are primarily exposed to a unimodal FBAP size distribution between 2 and 6 µm, with infants receiving greater exposures to super-10 µm FBAPs. In just 1 min of crawling or walking, 103-104 resuspended FBAPs can deposit in the respiratory tract, with an infant receiving much of their respiratory tract deposited dose in their lower airways. Per kg body mass, an infant will receive a nearly four times greater respiratory tract deposited dose of resuspended FBAPs compared to an adult.

Comparison of dobutamine ECG stress test with predischarge exercise test after acute myocardial infarction.

Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 +/- 1 days after the infarction and exercise testing was performed a mean of 10 +/- 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. It is inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.

Comparison of dobutamine electrocardiographic stress test and exercise test in two different groups of patients with unstable angina.

Exercise testing is a well known means of evaluating patients with unstable angina, but in recent years, alternative methods have been proposed. We prospectively compared standard exercise testing with dobutamine electrocardiographic stress testing for patients who were admitted with a diagnosis of unstable angina. A total of 43 patients were studied, divided into two different groups, according to the presence (group A n = 26) or absence (group B n = 17) of a previous history of coronary artery disease and/or electrocardiographic changes compatible with ischemia on admission. Dobutamine electrocardiographic stress testing was performed in a standard manner at 3 +/- 1 days after admission in group A and at 16 +/- 8 hours after admission in group B. Exercise testing was performed, on average 5 +/- 1 days following the event in group A and 2 days after admission in group B. Agreement between both tests was observed in 39 (91%) cases, Kappa value: 0.81. The dobutamine test predicted the result of the exercise test with a sensitivity of 79% (95% CI 54-90), and a specificity of 100% (95% CI 86-100), with a positive predictive value of 100% and a negative predictive value of 86%. It can be concluded that dobutamine electrocardiographic stress testing is an objective and reliable procedure that accurately predicts the results of standard exercise testing in patients with a diagnosis of unstable angina. If this result were confirmed with a greater number of patients, it would be a good option for definitive diagnosis and risk stratification, in addition to being inexpensive and easy to perform. It can also be particularly useful for patients who cannot perform exercise.

[Acute pulmonary thromboembolism with severe hemodynamic compromise. The efficacy of systemic thrombolytic treatment in the coronary unit]. / Tromboembolismo pulmonar agudo con severo compromiso hemodinámico. Eficacia del tratamiento trombolitico por vía sistémica en la unidad coronaria.

A 79[correction of seventy]-year-old patient, who has been in bed a long time, suffered an episode of sudden dyspnea, tachycardia and tachypnea. An electrocardiogram registered at her admission in the coronary care unit showed a normal rhythm with right axis deviation and S1Q3T3 pattern and ST segment alterations. A ventilation-perfusion lung scanning demonstrated segmental perfusion defects with high probability of pulmonary embolism. She developed a low cardiac output syndrome, which neither responded to the volume expansion nor to the inotropic drugs. The bed-side hemodynamic measurements were a systolic pulmonary pressure of 60 mmHg, with a diastolic pressure of 18 mmHg and capillary wedge pressure of 13 mmHg with high pulmonary resistance. With this evidences, the diagnoses of massive pulmonary embolism was done, thrombolytic treatment was decided on. Two hundred and fifty thousands international units of streptokinase was administered, and then 100.000 UI/hour in 24 hours; after that with intravenous heparin. The low cardiac output syndrome disappeared. The patients recovered her systemic arterial pressure and her diuresis. The electrocardiographic signs vanished and both the pulmonary pressure and resistance decreased. We discussed the importance of intravenous thrombolytic treatment in massive pulmonary embolism. We concluded than this treatment is an useful strategy that not always needs a pulmonary arteriography, and could be used in low complexity centres, successfully in the massive pulmonary thromboembolism with severe hemodynamic damage.

[Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]. / Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis.

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of "early coronary reperfusion" with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50%, 2) descent of ST segment elevation of more than 50%, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis. / [Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of [quot ]early coronary reperfusion[quot ] with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50

, 2) descent of ST segment elevation of more than 50

, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis. / [Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of [quot ]early coronary reperfusion[quot ] with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50

, 2) descent of ST segment elevation of more than 50

, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusion precoz post-trombolisis / Elevation of ST segment and Bezold Jarisch reflex as evidence of early reperfusion post thrombolysis

El prognóstico de los pacientes con IAM depende en parte de la permeabilidad de la arteria "culpable". Es por lo tanto esencial reconocer precozmente el éxito de la terapia trombolítica. A los elementos clásicos de reperfusión, se han agregado otros indicios adicionales de éxito trombolítico como la activación del reflejo de Bezoid Jarisch (bradicardia e hipotensión arterial en pacientes con IAM inferior) y la sobreelevación adicional del segmento ST durante la infusión del trombolítico. Se describe el caso de un paciente de 41 años, que presentó IAM hiperagudo de cara inferior y que recibió precozmente tratamiento trombolítico. Durante la infusión de Estreptoquinasa (STK) se constataron estos indicios de reperfusión exitosa, además de los criterios tradicionales. La angiografía coronaria efectuada a los 6 días, corroboró la validez de estos hallazgos al encontrar la arteria responsable permeable. Se descartó isquemia por lo que se dio de alta al paciente, con tratamiento médico. La activación del reflejo de Bezold Jarisch en enfermos con IAM inferior repermeabilizados con trombolíticos y la elevación transitória adicional de segmento ST intrainfusión de STK son hallazgos precoces, que no han sido reportados en asociación o combinados con los demás elementos clásicos y pueden resultar de utilidad para predecir el éxito del tratamiento trombolítico en el IAM (AU)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusion precoz post-trombolisis / Elevation of ST segment and Bezold Jarisch reflex as evidence of early reperfusion post thrombolysis

El prognóstico de los pacientes con IAM depende en parte de la permeabilidad de la arteria "culpable". Es por lo tanto esencial reconocer precozmente el éxito de la terapia trombolítica. A los elementos clásicos de reperfusión, se han agregado otros indicios adicionales de éxito trombolítico como la activación del reflejo de Bezoid Jarisch (bradicardia e hipotensión arterial en pacientes con IAM inferior) y la sobreelevación adicional del segmento ST durante la infusión del trombolítico. Se describe el caso de un paciente de 41 años, que presentó IAM hiperagudo de cara inferior y que recibió precozmente tratamiento trombolítico. Durante la infusión de Estreptoquinasa (STK) se constataron estos indicios de reperfusión exitosa, además de los criterios tradicionales. La angiografía coronaria efectuada a los 6 días, corroboró la validez de estos hallazgos al encontrar la arteria responsable permeable. Se descartó isquemia por lo que se dio de alta al paciente, con tratamiento médico. La activación del reflejo de Bezold Jarisch en enfermos con IAM inferior repermeabilizados con trombolíticos y la elevación transitória adicional de segmento ST intrainfusión de STK son hallazgos precoces, que no han sido reportados en asociación o combinados con los demás elementos clásicos y pueden resultar de utilidad para predecir el éxito del tratamiento trombolítico en el IAM

Miocarditis chagásica: observación de un caso / Chagasic myocarditis: observation of a case

Se describe el cuadro clínico de un paciente masculino, de 67 años de edad, derivado de un Hospital de la provincia de Buenos Aires, que presentaba un cuadro de insuficiencia cardíaca congestiva con dilatación predominante de las cavidades derechas, alteraciones electrocardiográficas progresivas (ritmo auricular errático, fibrilación auricular, BCRD, BAV de ler. grado y finalmente BAVC), y reacción de Machado Guerreiro positiva, falleciendo con una bronconeumonía bilateral y embolias pulmonares múltiples. El estudio anatomopatológico demostró la presencia de cardiomegalia con dilatación de las cuatro cavidades, en especial del lado derecho y la microscopía óptica reveló la existencia de edema infiltrado mononuclear y nidos de amastigotes compatibles con la enfermedad de Chagas en etapa aguda. Se observó también un trombo en la orejuela derecha y la presencia de embolias múltiples en vasos pulmonares. La miocarditis aguda o subaguda Chagásica, aunque rara, debe sospecharse en presencia de insuficiencia cardíaca con dilatación predominante de cavidades derechas, arritmias, bloqueos y serología positiva, para la enfermedad de Chagas. En estos casos debería buscarse el parásito mediante examen microscópico (gota gruesa) y xenodiagnóstico y eventualmente realizarse una biopsia endomiocárdica para su diagnóstico y tratamiento (AU)

Miocarditis chagásica: observación de un caso / Chagasic myocarditis: observation of a case

Se describe el cuadro clínico de un paciente masculino, de 67 años de edad, derivado de un Hospital de la provincia de Buenos Aires, que presentaba un cuadro de insuficiencia cardíaca congestiva con dilatación predominante de las cavidades derechas, alteraciones electrocardiográficas progresivas (ritmo auricular errático, fibrilación auricular, BCRD, BAV de ler. grado y finalmente BAVC), y reacción de Machado Guerreiro positiva, falleciendo con una bronconeumonía bilateral y embolias pulmonares múltiples. El estudio anatomopatológico demostró la presencia de cardiomegalia con dilatación de las cuatro cavidades, en especial del lado derecho y la microscopía óptica reveló la existencia de edema infiltrado mononuclear y nidos de amastigotes compatibles con la enfermedad de Chagas en etapa aguda. Se observó también un trombo en la orejuela derecha y la presencia de embolias múltiples en vasos pulmonares. La miocarditis aguda o subaguda Chagásica, aunque rara, debe sospecharse en presencia de insuficiencia cardíaca con dilatación predominante de cavidades derechas, arritmias, bloqueos y serología positiva, para la enfermedad de Chagas. En estos casos debería buscarse el parásito mediante examen microscópico (gota gruesa) y xenodiagnóstico y eventualmente realizarse una biopsia endomiocárdica para su diagnóstico y tratamiento

Prolapso valvular mitral: estudio comparativo de pacientes con y sin endocarditis infecciosa / Mitral valve prolapse: comparative study of patients with and without infective endocarditis

Durante un período de 6 años (marzo 1979-abril 1985) se estudiaron 11 pacientes con prolapso valvular mitral (PVM) y endocarditis infecciosa (EI) (grupo I) y se los conparó con 47 pacientes con PVM sin El ((grupo II) estudiados durante el mismo lapso. Se encontraron 4 hallazgos con significacción estadística que evidencian mayor conpromiso valvular en los del (grupo I: 1) diámetro diastólico del ventrículo ézquierdo (DDVI en mm): 56,09 + ou - 9,35 en el (grupo 1 vs 45,91 + ou - 6,67 en el (grupo II (p<0,01); 2) diámetro sistólico del ventrículo izquierdo (DSVI en mm): 35,18 + ou - 7,18 vs 28,46 + ou - 6,21 (p<0,01); 3) aurícula izquierda (AI en mm): 38,09 + ou - 7,51 vs 30,3 + ou - 6,76 (p<0,01), y 4 en el (grupo I el 82% de los pacientes presentaron una insuficiencia mitral (IM) moderada a grave vs el 10,6% del (grupo II (p<0,001). De los 11 pacientes del (grupo I, 8 fueron parte de una revisión de 44 casos consecutivos de EI tratados en nuestra cátedra en un período de 9 años; de éstos, 17 presentaban una IM aislada. Por lo tanto, el 47% de los casos de EI injertada sobre una IM aislada tratados en nuestro servicio fueron debidos a PVM. Se concluye que: 1) la gravedad de la IM en los pacientes con PVM y EI resultó ser mayor que en aquellos con PVM no infectado. Esto reflejaría un mayor deterioro valvular debido a la infección o alternativamente una mayor susceptibilidad a la infección en pacientes con IM más grave; 2) el PVM parece ser la lesión subyacente en un número sustancial de casos de EI y constituyó un 47% de los casos de EI en presencia de IM aislada (AU) &P

Prolapso valvular mitral: estudio comparativo de pacientes con y sin endocarditis infecciosa / Mitral valve prolapse: comparative study of patients with and without infective endocarditis

Durante un período de 6 años (marzo 1979-abril 1985) se estudiaron 11 pacientes con prolapso valvular mitral (PVM) y endocarditis infecciosa (EI) (grupo I) y se los conparó con 47 pacientes con PVM sin El ((grupo II) estudiados durante el mismo lapso. Se encontraron 4 hallazgos con significacción estadística que evidencian mayor conpromiso valvular en los del (grupo I: 1) diámetro diastólico del ventrículo ézquierdo (DDVI en mm): 56,09 + ou - 9,35 en el (grupo 1 vs 45,91 + ou - 6,67 en el (grupo II (p<0,01); 2) diámetro sistólico del ventrículo izquierdo (DSVI en mm): 35,18 + ou - 7,18 vs 28,46 + ou - 6,21 (p<0,01); 3) aurícula izquierda (AI en mm): 38,09 + ou - 7,51 vs 30,3 + ou - 6,76 (p<0,01), y 4 en el (grupo I el 82% de los pacientes presentaron una insuficiencia mitral (IM) moderada a grave vs el 10,6% del (grupo II (p<0,001). De los 11 pacientes del (grupo I, 8 fueron parte de una revisión de 44 casos consecutivos de EI tratados en nuestra cátedra en un período de 9 años; de éstos, 17 presentaban una IM aislada. Por lo tanto, el 47% de los casos de EI injertada sobre una IM aislada tratados en nuestro servicio fueron debidos a PVM. Se concluye que: 1) la gravedad de la IM en los pacientes con PVM y EI resultó ser mayor que en aquellos con PVM no infectado. Esto reflejaría un mayor deterioro valvular debido a la infección o alternativamente una mayor susceptibilidad a la infección en pacientes con IM más grave; 2) el PVM parece ser la lesión subyacente en un número sustancial de casos de EI y constituyó un 47% de los casos de EI en presencia de IM aislada (AU) &P