Ischemic Lesions in the Brain of a Neonate With SARS-CoV-2 Infection.

AIM: To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain. BACKGROUND: Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported. CASE DESCRIPTION: We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented. CONCLUSIONS: SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found. CLINICAL SIGNIFICANCE: Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Implementación de un programa de mejoramiento de la seguridad de los pacientes: resultados preliminares / Implementation of a program of improvement of the security of the patients: preliminary results

Tradicionalmente, el error ha servido para aprender lo que no había que hacer y lo que no era verdad. Luego se sumó la reacción de castigar al responsable del error suponiendo que éste era producto de la incapacidad o irresponsabilidad individual. La búsqueda, explícita o no, del "culpable" ha promovido mayor temor en los profesionales de la salud y generado una creciente tendencia a ocultar los errores. Desde 2001, la Academia Nacional de Medicina, a través de su Centro de Investigaciones Epidemiológicas, desarrolló e implementó un programa para el mejoramiento de la seguridad en la atención de los pacientes, en cuatro instituciones sanitarias de nuestro país de diferentes características. El propósito del programa es: "diseñar, validar y evaluar metodologías que permitieran identificar errores, casi errores y eventos adversos; analizar el mecanismo de su producción y contribuir a señalar los procesos correctivos". El mismo está organizado en cuatro componentes: a) cultura organizacional para la seguridad del paciente; b) sistemas de información para la vigilancia del error durante el proceso de atención, c) mejoramiento continuo de la seguridad del paciente y d) gestión de conocimiento.

Resistance to antibiotics in injured coliforms isolated from drinking water.

We studied the antibiotic sensitivity of injured coliforms isolated from drinking water of La Plata, Argentina. The antibiotic sensitivity test by the agar diffusion method were proved in: Klebsiella oxytoca (14 strains), Enterobacter aerogenes (4 strains) and Enterobacter cloacae genomic group 3 (14 strains). We found that while these impaired total coliforms were sensitive to piperacillin-tazobactam (TAZ), netilmicin (NTL), ofloxacin (OFLX), and norfloxacin (NFLX) (100%), they had resistant to aminopenicillin-sulbactam (AMS) and nitrofurantoin (NIT) (100%). The resistance to antibiotics demonstrated in these strains would point to the need to promote a rational and judicious use of antimicrobial agents while at the same time implementing a program of active vigilance aimed at ensuring the highest quality of drinking water throughout the system.

[Isolation and characterization of injured coliforms from the drinking water distribution network of La Plata, Argentina]. / Aislamiento y caracterización de coliformes injuriados provenientes de la red de distribución de agua de bebida de La Plata, Argentina.

We screened the La Plata drinking water distribution network for fecal and total coliform bacterial indicator by purification procedures, cultivating 66 membrane-filtered samples from the two networks on m-T7 agar. Subterranean and river-derived water yielded 13 and 18 confirmed gram-negative bacillus isolates, with 54% and 72% representing total coliforms, respectively. Those from the former source were Klebsiella oxytoca, Enterobacter agglomerans, and Enterobacter aerogenes and from the latter Klebsiella oxytoca, Enterobacter agglomerans, and Enterobacter cloacae, genomic group 3. Since 58% of the samples were positive using m-T7 medium it is suggested that the inclusion in standard quality control protocols should be implemented.

Aislamiento y caracterización de coliformes injuriados provenientes de la red de distribución de agua de bebida de La Plata, Argentina. / [Isolation and characterization of injured coliforms from the drinking water distribution network of La Plata, Argentina]

We screened the La Plata drinking water distribution network for fecal and total coliform bacterial indicator by purification procedures, cultivating 66 membrane-filtered samples from the two networks on m-T7 agar. Subterranean and river-derived water yielded 13 and 18 confirmed gram-negative bacillus isolates, with 54

and 72

representing total coliforms, respectively. Those from the former source were Klebsiella oxytoca, Enterobacter agglomerans, and Enterobacter aerogenes and from the latter Klebsiella oxytoca, Enterobacter agglomerans, and Enterobacter cloacae, genomic group 3. Since 58

of the samples were positive using m-T7 medium it is suggested that the inclusion in standard quality control protocols should be implemented.

Screening of the municipal water system of La Plata, Argentina, for human intestinal parasites.

The La Plata River, though severely contaminated by intestinal parasites through the discharge of tons of crude fecal material from a main sewage channel, nevertheless provides drinking water to two-thirds of La Plata, Argentina, after conventional purification at a processing plant. With intestinal parasitosis being endemic here, we investigated the importance of this water in transmitting such pathogens to the city's populace by means of standard methodology for sample acquisition and processing involving filter-concentration of waterborne particulates. Of 14 tap-water samples collected from the distribution network, 12 pertained to four zones (A-D) within the city center; while the remaining 2 were obtained near the processing plant, 15 kilometers outside the city. Although parasites were found within the samples derived from the four urban zones, none were detected in the specimens obtained near the plant. The four downtown areas differed from each other as to the quantity and nature of the parasites present in their water: whereas zones A and B registered similar lower levels of contaminants, C and D exhibited higher values significantly different from the former two and from each other. Given an average parasite count/l citywide of 0.38 and a probability of encountering a parasite within 11 of water of 0.32, the municipal network is seen to contribute to the transmission of intestinal parasites. A routine system of water-quality control is therefore needed throughout the city along with the establishment of infrastructures for locating and eliminating peripheral sources of contamination.

A very stable W/O/W multiple emulsion.

The comparison of the results of microscopic, conductimetric and rheologic analyses carried out on the same triple W/O/W emulsion, immediately following its manufacture and 10 years later, indicates the remarkable stability of such system. This stability illustrates the great potential of this formula in the protection of unstable ingredients, with regard to external stress, when encapsulated with a high yield.

[Relationship between discontinuous sucrose gradient and viability of Cryptosporidium sp. oocysts]. / Relación entre el gradiente discontinuo de sacarosa y la viabilidad de ooquistes de Cryptosporidium sp.

Cryptosporidium sp. causes self-limiting gastroenteritis in immunocompetent individuals and can produce a life-threatening chronic diarrhea in immunodeficient patients. In order to obtain populations of selectively infective oocysts for inoculation in biological experiments, we developed an operational protocol for the enrichment of viable oocysts from crude fecal material. Using either fresh or formaldehyde-fixed feces as sources of viable and nonviable oocysts, respectively, we fractionated the samples on parallel discontinuous sucrose gradients and evaluated oocyst viability at different banding densities by an in vitro excystation assay. The formaldehyde-inactivated fecal samples formed no bands after centrifugation and 91.66% of the oocysts became concentrated in the pellet. Fresh fecal samples formed three bands at densities 1.062, 1.092, and 1.121, in addition to a sediment. Here the viability of the gradient-sedimented oocysts was 92.3% overall, and of those in the second band 100%. Modifications in oocyst permeability thus seems to alter their sedimentation characteristics so that consequent distribution on sucrose gradients can be correlated with oocyst viability. Discontinuous sucrose density gradient sedimentation would thus constitute a simple and rapid mean to obtain viable oocysts for use in biological models both in vivo and in vitro.

[Factors affecting the in vitro excystation of Cryptosporidium sp]. / Factores que influyen en el desenquistamiento in vitro de Cryptosporidium sp.

To assess the viability of the oocysts from Cryptosporidium sp, an in vitro excystation technique was developed and optimized. To this end, oocysts from Cryptosporidium sp were isolated from a sample of fecal material from a child with symptomatic cryptosporidiosis. The specimen was processed by a discontinuous-sucrose-gradient technique yielding a final suspension of purified and concentrated oocysts. The resulting oocysts were quantified by counting an aliquot in a Neubauer hemocytometer chamber and the remainder were preserved in phosphate-buffered saline at pH 7.2 and 4 degrees C. The two protocols tested through the use of 100-microliter aliquots containing 178,000 oocytes/mm3 were: I. Treatment at 37 degrees C for 24 h with 1% (v/v) bile plus 0.44% (w/v) sodium bicarbonate. Group A: pretreated with acidified trypsin (pH 2.75) at 37 degrees C for 1 h; Group B: not pretreated. II. Treatment at 37 degrees C for 24 h with 1% (v/v) bile at pH 6 and at pH 8 either with or without 0.44% (w/v) sodium bicarbonate in air or an atmosphere containing 10% (v/v) CO2. Group 1: bile, pH 6; Group 2: bile, pH 6 plus CO2; Group 3: bile, pH 6 plus bicarbonate; Group 4: bile, pH 8 plus bicarbonate; Group 5: bile, pH 6 plus bicarbonate plus CO2; Group 6: bile, pH 8 plus bicarbonate plus CO2; Group 7: bile, pH 8; and Group 8: bile, pH 8 plus CO2. We then assessed the degree of excystation in all the groups by counting the number of intact oocysts in the hemocytometer. For the first protocol, the oocyst count after excystation revealed an average of 28,000 oocysts/mm3 in Group A and 22,000 in Group B. These values indicate excystation frequencies of 84.3% and 87.6% for these two groups, respectively. The corresponding excystation percentages for groups 1-8 of protocol II were 49.5, 56.7, 83.2, 88.3, 88.3, 92.7, and 94.1, respectively. Preincubation with trypsin failed to augment oocyst excystation in Cryptosporidium in any of these experimental circumstances. The optimal conditions for oocyst excystation in these 24 h incubations were thus seen to be in the presence of 1% (v/v) bile at pH 8, and 37 degrees C under an atmosphere of 10% (v/v) CO2.

Factores que influyen en el desenquistamiento in vitro de Cryptosporidium sp / Factors affecting the in vitro excystation of Cryptosporidium sp

Para evaluar la viabilidad de los ooquistes de Cryptosporidium sp se desarrolló y optimizó una técnica de desenquistamiento in vitro. Los ooquistes de Cryptosporidium sp se obtuvieron de una muestra de materia fecal de un niño con cryptosporidiosis sintomática. La muestra fue procesada por la técnica de gradiente discontinuo de sacarosa hasta obtener una suspensión de ooquistes purificados y concentrados (OPC). Los ooquistes se cuantificaron en cámara de Neubauer y preservaron en PBS pH 7, 2 a 4§C. Los dos protocolos ensayados a partir de alícuotas de 100µl de OPC con 178.000 ooquistes/mm3 fueron: I. Tratamiento con bilis 1 por ciento y bicarbonato de sodio al 0,44 por ciento a 37§C durante 24 horas. II Tratamiento con bilis 1 por ciento con pH 6 y pH 8, con y sin bicarbonato de sodio al 0,44 por ciento, con y sin incubación en atmósfera de 10 por ciento de CO2 durante 24 h a 37§C. Se evaluó el grado de desenquistamiento en todos los grupos efectuando el conteo de ooquistes intactos en cámara de Neubauer. La preincubación con tripsina no incrementó el desenquistamiento de los ooquistes de Cryptosporidium sp. Las mejores condiciones de desenquistamiento fueron utilizando bilis al 1 por ciento pH 8, incubado con 10 por ciento de CO2, a 37§C durante 24 h.

Factores que influyen en el desenquistamiento in vitro de Cryptosporidium sp / Factors affecting the in vitro excystation of Cryptosporidium sp

Para evaluar la viabilidad de los ooquistes de Cryptosporidium sp se desarrolló y optimizó una técnica de desenquistamiento in vitro. Los ooquistes de Cryptosporidium sp se obtuvieron de una muestra de materia fecal de un niño con cryptosporidiosis sintomática. La muestra fue procesada por la técnica de gradiente discontinuo de sacarosa hasta obtener una suspensión de ooquistes purificados y concentrados (OPC). Los ooquistes se cuantificaron en cámara de Neubauer y preservaron en PBS pH 7, 2 a 4ºC. Los dos protocolos ensayados a partir de alícuotas de 100Al de OPC con 178.000 ooquistes/mm3 fueron: I. Tratamiento con bilis 1 por ciento y bicarbonato de sodio al 0,44 por ciento a 37ºC durante 24 horas. II Tratamiento con bilis 1 por ciento con pH 6

Ultrasensitive in vivo bioassay detects bioactive human growth hormone in transduced primary human keratinocytes.

An improved in vivo body weight gain bioassay for the potency determination of human growth hormone (hGH) has been set up in "little" mice (lit/lit), a mutant derived from the C57BL/6J strain. This improved assay now has a detection limit of the order of 0.05 micrograms/mouse/day, which corresponds to a sensitivity about 20-fold higher than that of the most sensitive in vivo assay reported up to now: the tibia test in hypophysectomized rats or mice. This sensitivity was achieved mainly by introduction of a careful pre-assay selection and of a three injections per day schedule. The utilization of these conditions in a 2x2 factorial assay design allowed the potency determination of recombinant DNA-derived hGH (rec-hGH) in bacterial extracts with acceptable accuracy and precision, together with the greatest economy of material, only 0.24 mg of unknown and standard hormone preparation being sufficient for an entire 10-animal assay. This contrasts to a minimum of 2.7 mg that are necessary for an economical assay in hypophysectomized rats. The same assay procedure was also used to demonstrate the in vivo bioactivity of hGH secreted into a culture medium from transduced human primary keratinocytes. The growth curve constructed with n = 8 little mice presented a highly significant correlation (r = 0.939, p < 0.001) and a slope = 0.016 g/mouse/day. It was thus possible to prove, for the first time, the in vivo bioactivity of rec-hGH secreted by transplantable human epidermal cells, utilized as an experimental model for somatic gene therapy.

Characterization and quantitation of parasite species in the effluents of the Berisso main sewage channel, Buenos Aires, Argentina.

Outbreaks of disease can be caused by pathogenic intestinal parasites in drinking water. La Plata, the capital of the province of Buenos Aires, Argentina, is located on the La Plata River; a principal tributary receiving the raw sewage from the city's 500,000 inhabitants via the Berisso main septic channel at an estimated volume of 108,390 m3/day (4516.3m3/h). To determine the parasite-contamination level of the La Plata River, we obtained 18 sewage effluents from the Berisso main septic channel at its point of discharge into the river and concentrated these samples by filtration. This approach detected the following parasites at the indicated average levels (cysts/m3): members of the flagellate genus Giardia, more than 9000; representatives of the amoebic species Entamoeba histolytica, slightly more than 800 and Entamoeba coli, 5000; other amoebic forms, up to 23,000. These data clearly illustrate the degree of contamination within the La Plata River caused by the Berisso septic channel. Pollution of the La Plata River to this extent thus presents a high health risk for people who drink the water from this river even after conventional processing as well as for those who use the water from this portion of the river for recreation.

[Intestinal parasite infections in a periurban community from the Province of Buenos Aires, Argentina]. / Estudio de las infecciones por enteroparásitos en una comunidad periurbana de la provincia de Buenos Aires, Argentina.

A survey for intestinal parasites was performed on 38 individuals within the urban area of La Plata City (Province of Buenos Aires, Argentina). This community is composed of brick-factory workers who also live in the factory premises. An analysis for intestinal parasites was done on fecal samples collected serially and by means of anal swabs and thereafter preserved in formol solution. At the same time, the occurrence of the parasites under study as well as that of commensal organisms was investigated in water and soil samples within the factory environs. Information was also obtained from the members of this community as their age, sex, birthplace, and recent travels, either abroad or to the interior of Argentina. The prevalence of the pathogens and commensal parasites was 89.5%. The frequency of protozoans and helminths was: G. lamblia 26.3%, B. hominis 65.8%, A. lumbricoides 7.9%, H. nana 2.6%, Uncinaria sp. 7.9%, S. stercoralis 2.6% and E. vermicularis 42.1%. None of these parasite or commensal organisms were present in the water samples investigated. Four out of 20 soil samples analyzed contained parasitic elements: T. canis eggs (one), G. lamblia cysts (two) and A. lumbricoides eggs (one). These results indicated that most important factors causing such a high prevalence of coproparasites were the poor conditions of personal and community hygiene in combination with the frequent travels to the north and the northeast of the country, regions which are endemic parasitic areas. The implementation of programs on health education and communal sanitation would contribute in the control of this health problem.

Síndrome de dificultad respiratoria y falla del miocardio en el recién nacido asfixiado / Respiratory distress syndrome and myocardial failure in the asphyxiated neomate

Algunos recién nacidos (RN) asfixiados presentan un cuadro de dificultad respiratoria (DR) por falla miocárdica secundaria a isquemia. Tres neonatos con esta patología plantearon dificultades en el diagnóstico diferencial con dificultad respiratoria de origen pulmonar. Dos niños fueron prematuros de bajo peso con diagnóstico clínico-radiológico inicial de enfermedad membrana hialina grave (EMHG). En el primero los bajos requerimientos de asistencia respiratoria mecánica (ARM) hicieron sospechar que la opacidad radiológica se debía a edema pulmonar. El segundo paciente estaba hipotenso y no respondió a expansores de volumen. Ambos respondieron a la administración de diuréticos y dopamina con rápida mejoría clínico-radiológica. El tercer paciente fue un RN de término con antecedentes de hipoxia, acidosis y alta necesidad de oxígeno y ARM que hacían sospechar hipertensión pulmonar persistente (HPP), que se trató con hiperventilación. Una presión venosa central (PVC) alta y signos clínicos y radiológicos sugirieron shock cardiogénico por lo que se agregó dopamina y diuréticos con excelente respuesta. En la falla miocádica neonatal la radiografía puede mostrar cardiomegalia y edema pulmonar. Los cambios electrocardiográficos de la onda T y el segmento ST deben ser interpretados en relación con las horas de vida. Las determinaciones de PVC y tensión arterial (T.A.) contribyen al diagnóstico clínico y al manejo terapeútico racional. La isoenzima MB de la creatinfosfoquinasa (CPK) se eleva en la isquemia miocárdica aunque su interpretación debe relacionarse a valores del mismo laboratorio para RN normales. Otros estudios pueden contribuir al diagnóstico aunque no fueron realizados en estos niños. La ecografía modo M puede mostrar mala contractilidad miocárdica e intervalo sistólico izquierdo prolongado. La centellografía con talio 201 y la hemodinamia quedan reservadas para pacientes con diagnóstico diferencial difícil. El tratamiento apunta a revertir el shock cardiogénico, basándose en manejo adecuado de soluciones hidroelectrolíticas, uso de diuréticos y drogas inotrópicas. El conocimiento de este cuadro y la sospecha clínica precoz son indispensables para evitar demoras diagnósticas y terapéuticas inadecuadas

Síndrome de dificultad respiratoria y falla del miocardio en el recién nacido asfixiado / Respiratory distress syndrome and myocardial failure in the asphyxiated neomate

Algunos recién nacidos (RN) asfixiados presentan un cuadro de dificultad respiratoria (DR) por falla miocárdica secundaria a isquemia. Tres neonatos con esta patología plantearon dificultades en el diagnóstico diferencial con dificultad respiratoria de origen pulmonar. Dos niños fueron prematuros de bajo peso con diagnóstico clínico-radiológico inicial de enfermedad membrana hialina grave (EMHG). En el primero los bajos requerimientos de asistencia respiratoria mecánica (ARM) hicieron sospechar que la opacidad radiológica se debía a edema pulmonar. El segundo paciente estaba hipotenso y no respondió a expansores de volumen. Ambos respondieron a la administración de diuréticos y dopamina con rápida mejoría clínico-radiológica. El tercer paciente fue un RN de término con antecedentes de hipoxia, acidosis y alta necesidad de oxígeno y ARM que hacían sospechar hipertensión pulmonar persistente (HPP), que se trató con hiperventilación. Una presión venosa central (PVC) alta y signos clínicos y radiológicos sugirieron shock cardiogénico por lo que se agregó dopamina y diuréticos con excelente respuesta. En la falla miocádica neonatal la radiografía puede mostrar cardiomegalia y edema pulmonar. Los cambios electrocardiográficos de la onda T y el segmento ST deben ser interpretados en relación con las horas de vida. Las determinaciones de PVC y tensión arterial (T.A.) contribyen al diagnóstico clínico y al manejo terapeútico racional. La isoenzima MB de la creatinfosfoquinasa (CPK) se eleva en la isquemia miocárdica aunque su interpretación debe relacionarse a valores del mismo laboratorio para RN normales. Otros estudios pueden contribuir al diagnóstico aunque no fueron realizados en estos niños. La ecografía modo M puede mostrar mala contractilidad miocárdica e intervalo sistólico izquierdo prolongado. La centellografía con talio 201 y la hemodinamia quedan reservadas para pacientes con diagnóstico diferencial difícil. El tratamiento apunta a revertir el shock cardiogénico, basándose en manejo adecuado de soluciones hidroelectrolíticas, uso de diuréticos y drogas inotrópicas. El conocimiento de este cuadro y la sospecha clínica precoz son indispensables para evitar demoras diagnósticas y terapéuticas inadecuadas (AU)