Dengue-specific serotype related to clinical severity during the 2012/2013 epidemic in centre of Brazil.

Please see Additional file 1 for translations of the abstract into the five official working languages of the United Nations. BACKGROUND: Currently, in Brazil, there is a co-circulation of the four dengue (DENV-1 to DENV-4) serotypes. This study aimed to assess whether different serotypes and antibody response patterns were associated with the severity of the disease during a dengue outbreak, which occurred in 2012/2013 in centre of Brazil. METHODS: We conducted a prospective study with 452 patients with laboratory confirmed dengue in central Brazil, from January 2012 to July 2013. The clinical outcome was the severity of cases: dengue, dengue with warning signs, and severe dengue. The patients were evaluated at three different moments. Blood sampling for laboratory testing and confirmatory tests for dengue infection were performed. We performed a multinomial analysis considering the three categories of the dependent variable, as outlined above. The odds ratios (ORs) were calculated. A multinomial logistic regression model was applied for variables with a P-value <0.20. Statistical analysis was performed with STATA 12.0 software. RESULTS: Four hundred fifty-two patients (452/632, 71.5%) were diagnosed with dengue. The dengue virus (DENV) serotypes were identified in 243 cases. DENV-4 was detected in 135 patients (55.6%), DENV-1 in 91 (37.4%), DENV-3 in 13 (5.3%), and DENV-2 in 4 (1.6%). Patients with the DENV-1 serotype were more prone to present with several clinical and laboratory features as compared with DENV-4 patients, including spontaneous bleeding (P = 0.03), intense abdominal pain (P = 0.004), neurological symptoms (P = 0.09), and thrombocytopenia (P = 0.01). Secondary infection was more predominant among DENV-4 cases (80.0%) compared with DENV-1 cases (62.3%) (P = 0.03). The univariate analysis showed that females (OR = 2.12; 95% CI: 1.44-3.13; P < 0.01) had a higher risk of having dengue with warning signs. The multinomial analysis showed that severe dengue cases with secondary infection had an adjusted OR of 2.80 (95% CI: 0.78-10.00; P = 0.113) as compared with dengue fever with primary infection when adjusted for age and sex. CONCLUSION: The current data show that 5.8% of patients recruited for treatment in healthcare centres and hospitals during the study period had severe dengue. DENV-4 was the predominant serotype, followed by DENV-1, in a large outbreak of dengue in central Brazil. Our findings contribute to the understanding of clinical differences and immune status related to the serotypes DENV-1 and DENV-4 in central of Brazil.

Temporal patterns of rat behaviour in the central platform of the elevated plus maze. Comparative analysis between male subjects of strains with different basal levels of emotionality.

We have analyzed the temporal patterns of behaviour of male rats of the Wistar and DA/Han strains on the central platform of the elevated plus maze. The ethogram encompassed 10 behavioural elements. Durations, frequencies and latencies showed quantitative differences as to walking and sniffing activities. Wistar rats displayed significantly lower latency and significantly higher durations and frequencies of walking activities. DA/Han rats showed a significant increase of sniffing duration. In addition, DA/Han rats showed a significantly higher amount of time spent in the central platform. Multivariate T-pattern analysis revealed differences in the temporal organization of behaviour of the two rat strains. DA/Han rats showed (a) higher behavioural complexity and variability and (b) a significantly higher mean number of T-patterns than Wistar rats. Taken together, T-pattern analysis of behaviour in the centre of the elevated plus maze can noticeably improve the detection of subtle features of anxiety related behaviour. We suggest that T-pattern analysis could be used as sensitive tool to test the action of anxiolytic and anxiogenic manipulations.

T-pattern analysis for the study of temporal structure of animal and human behavior: a comprehensive review.

A basic tenet in the realm of modern behavioral sciences is that behavior consists of patterns in time. For this reason, investigations of behavior deal with sequences that are not easily perceivable by the unaided observer. This problem calls for improved means of detection, data handling and analysis. This review focuses on the analysis of the temporal structure of behavior carried out by means of a multivariate approach known as T-pattern analysis. Using this technique, recurring sequences of behavioral events, usually hard to detect, can be unveiled and carefully described. T-pattern analysis has been successfully applied in the study of various aspects of human or animal behavior such as behavioral modifications in neuro-psychiatric diseases, route-tracing stereotypy in mice, interaction between human subjects and animal or artificial agents, hormonal-behavioral interactions, patterns of behavior associated with emesis and, in our laboratories, exploration and anxiety-related behaviors in rodents. After describing the theory and concepts of T-pattern analysis, this review will focus on the application of the analysis to the study of the temporal characteristics of behavior in different species from rodents to human beings. This work could represent a useful background for researchers who intend to employ such a refined multivariate approach to the study of behavior.

Conservative management of pituitary tumor apoplexy.

Pituitary tumor apoplexy is a rare neuroendocrine syndrome resulting, in most cases, from hemorrhage or infarctation of a pre-existing pituitary adenoma. Treatment recommendations vary; some authors advocate urgent surgical decompression of the tumor, whereas others suggest that conservative management can lead to recovery of neuro-ophthalmologic function. We describe two patients with pituitary tumor apoplexy who had clinically non-functioning macroadenomas and hypopituitarism, including hypogonadism. They were treated conservatively without surgery, and achieved tumor remission.

Pretreatment levels of soluble cellular receptors and interleukin-6 are associated with HIV disease progression in subjects treated with highly active antiretroviral therapy.

BACKGROUND: To identify inflammatory pathways that may contribute to the pathogenesis of human immunodeficiency virus (HIV) disease, we explored associations between AIDS or death and different inflammatory markers, including selected soluble tumor necrosis factor superfamily receptors (sTNFRs) and ligands, interleukin (IL)-6, and CD8 T cell activation, in individuals treated with highly active antiretroviral therapy (HAART). METHODS: A case-control study of subjects in AIDS Clinical Trials Group (ACTG) protocols 384 and 5015, who were matched according to the CD4 cell count and plasma viral load at baseline, was performed using conditional logistic regression. RESULTS: Higher pretreatment concentrations of sTNFR-1, sCD27, sCD40L, and plasma IL-6 were associated with a new AIDS-defining illness or death in separate models adjusted for age, sex, hemoglobin, and the latest CD4 cell counts. In additional models that excluded case patients with opportunistic infections, sTNFR-1, sCD27, and sCD40L were each associated with a new AIDS-defining malignancy or death that developed at a median of 51 weeks after initiation of HAART, by which time the majority of subjects had a CD4 cell count of >200 cells/cm(3) and had achieved a plasma viral load of <50 copies/mL. CONCLUSION: These data are compatible with a model in which these soluble inflammatory markers identify pathways that may contribute to the pathogenesis of HIV disease progression, pathways that might not be a direct consequence of ongoing HIV type 1 replication.

Incomplete reconstitution of T cell subsets on combination antiretroviral therapy in the AIDS Clinical Trials Group protocol 384.

BACKGROUND: Initiation of combination antiretroviral therapy (ART) results in higher total CD4 cell counts, a surrogate for immune reconstitution. Whether the baseline CD4 cell count affects reconstitution of immune cell subsets has not been well characterized. METHODS: Using data from 978 patients (621 with comprehensive immunological assessments) from the AIDS [Acquired Immunodeficiency Syndrome] Clinical Trials Group protocol 384, a randomized trial of initial ART, we compared reconstitution of CD4(+), CD4(+) naive and memory, CD4(+) activation, CD8(+), CD8(+) activation, B, and natural killer cells among patients in different baseline CD4(+) strata. Reference ranges for T cell populations in control patients negative for human immunodeficiency virus (HIV) infection were calculated using data from AIDS Clinical Trials Group protocol A5113. RESULTS: Patients in the lower baseline CD4(+) strata did not achieve total CD4(+) cell counts similar to those of patients in the higher strata during 144 weeks of ART, although CD4(+) cell count increases were similar. Ratios of CD4(+) naive-memory cell counts and CD4(+):CD8(+) cell counts remained significantly reduced in patients with lower baseline CD4(+) cell counts (350 cells/mm(3) achieved or approached the reference range those of control individuals without HIV infection. In contrast, patients who began ART with

The attack on psychosomatic integrity: a study of the psychological sequelae of burn trauma.

Burns pathology is characterized not only by insidious damage to the patients' outward appearance but also by the equally painful emotional difficulties they encounter as they reorganize their identity and their personal history. This exploratory survey, combining research work with medical action, considers the cases of 41 outpatients who were hospitalized and subjected to skin grafting. The patients were recruited through the database of the Palermo Civic Hospital Plastic Surgery and Burns Therapy Operative Unit. The questionnaires were compiled 6 and 12 months post-burn (12 months' observation). The main objective of the research was to investigate the quality of life of burn patients in relation to the way they handled their condition on the emotional level, in order to cope with the stress caused by the burn.

Local treatment of burns with honeycomb expanded polyurethane (ligasano).

The results are presented of the local treatment of burns with honeycomb expanded polyurethane. This method of treatment can be used both for the medication of burns of limited extent but variable depth and as a mattress for patients confined to bed. In the first case, the purpose of the treatment, which makes use of the product's absorbent and debriding capacity, is either to cure the lesion or to pave the way for the surgical operation. In the second case use is made of the product's exudate-draining and anti-pressure sore activity, which prevents the lesion from becoming deeper.

Selective activation of 5-HT(2C) receptors stimulates GABA-ergic function in the rat substantia nigra pars reticulata: a combined in vivo electrophysiological and neurochemical study.

In vivo electrophysiology and microdialysis were used to investigate the physiological role of 5-HT(2C) receptors in the control of substantia nigra pars reticulata (SNr) function. Extracellular single-unit recordings were performed from putative GABA-containing neurons in the SNr of anesthetized rats, and local GABA release was studied by in vivo microdialysis in the SNr of awake freely-moving rats. Systemic administration of the selective 5-HT(2C) receptor agonist (S)-2-(chloro-5-fluoro-indol-1-yl)-1-methylethylamine 1:1 C(4)H(4)O(4) (RO 60-0175) caused a dose-dependent excitation of about 30% of the SNr neurons recorded. However, the remaining neurons were either inhibited or unaffected by systemic RO 60-0175, in similar proportion. Local application of RO 60-0175 by microiontophoresis caused excitation in the majority of SNr neurons tested (48%), whereas a group of neurons was inhibited (16%) or unaffected (36%). Both the excitatory and the inhibitory effects of systemic and microiontophoretic RO 60-0175 were completely prevented by pretreatment with SB 243213 [5-methyl-1-({2-[(2-methyl-3-pyridyl)oxy]-5-pyridyl}carbamoyl)-6-trifluoromethylindoline], a selective and potent 5-HT(2C) receptor antagonist. Consistent with these electrophysiological data, both systemic and intranigral administration of RO 60-0175 and m-chlorophenylpiperazine (mCPP), a non-selective 5-HT(2C) agonist, markedly increased extracellular GABA levels in the SNr. The stimulatory effect of systemic and local RO 60-0175 on GABA release was completely prevented by systemic administration of SB 243213, whereas local application of SB 243213 into the SNr only partially blocked RO 60-0175-induced GABA release. It is concluded that selective activation of 5-HT(2C) receptors stimulates GABA-ergic function in the SNr, and the clinical relevance of these data is discussed.

Myelodysplastic syndrome with atypical eosinophilia in association with ring chromosome 7. A case report.

The presence of morphologically abnormal eosinophils in the bone marrow and/or peripheral blood has been rarely reported as a prominent feature in myelodysplastic syndromes (MDS). Specific chromosomal aberrations have been observed in such cases. We report a case of a 76-year-old man who presented with chronic, transfusion-dependent anemia. Peripheral blood smear analysis revealed anisocytes, mild leukopenia, and occasional hypersegmented eosinophils. A subsequent bone marrow biopsy and aspiration disclosed hypercellularity, and morphologic abnormalities within the megakaryocyte, erythroid, and myeloid series. The myeloid population was predominantly comprised of eosinophils with varying degrees of dyspoiesis. The constellation of hematologic findings were without a precise categorization according to the FAB classification of myelodysplastic syndromes. Subsequent cytogenetic techniques demonstrated a ring chromosome 7 in all 20 metaphases analyzed in cultured bone marrow cells. Eighty-five-percent of the analyzed cells showed a ring chromosome composed of both the long and short arms: r(7)(p22q36). In the remaining metaphases, the ring was composed of only the short arm: r(7)(p22q10). To our knowledge, these uncommon cytogenetic abnormalities have not been previously reported in association with MDS with morphologically atypical bone marrow or peripheral eosinophilia.

[6 cases of small intestine lymphoma]. / Sei casi di linfoma dell'intestino tenue.

The Authors report six cases of primitive and secondary intestinal lymphomas. Surgical radicality was achieved only in three of them. In the other cases surgical resection carried out in emergency and late histological diagnosis did not allow a correct surgical treatment. Peri-operative mortality was 16%. Five patients underwent adequate radiation and chemo-therapy programme. Recurrences, secondary localizations, or other neoplasms elsewhere, require a prolonged follow up period for these patients.

Isolation and characterization of conditionally immortalized astrocyte cell lines derived from adult human spinal cord.

As an approach to develop both oligodendrocytic and astrocytic cell lines from adult human spinal cord, a cellular preparation of highly enriched oligodendrocytes and their precursors was infected with a replication-deficient retrovirus containing DNA sequences encoding the temperature-sensitive mutant of SV40 large T antigen. Six immortal cell lines were obtained. At both permissive (33 degrees C) and non-permissive (38.5 degrees C) temperatures, all cell lines were positive for vimentin, two demonstrated glial fibrillary acidic protein (GFAP) immunoreactivity, and none expressed oligodendrocyte or microglial markers. The 2 GFAP-positive cell lines [human spinal cord (HSC)2 and HSC6] were further characterized. Karyotype analysis revealed that both HSC2 and HSC6 cells showed gain of chromosomal material and structural chromosomal abnormalities. However, at non-permissive temperature both cell lines were indistinguishable from primary human astrocytes by a number of criteria. These properties included glutamine synthetase activity, Na(+)-dependent glutamate uptake, K+ flux, purine-evoked Ca2+ mobilization and entry, and the ability to support neurite outgrowth from embryonic rat retinal explants. The HSC2 and HSC6 cell lines may prove to be valuable models for studying the physiological properties of adult human astrocytes.

Circling behavior: ethological analysis and functional considerations.

Head-turning and circling movements evoked by substantia nigra (pars compacta) (SNpc) stimulation have been ethologically analyzed in order to attribute a functional meaning to these lateralization processes. It has been shown that these motor acts, separated by a constant interval, may be considered a fixed action pattern. The duration of the single acts depends on the SNpc stimulation parameters: the increase in the stimulus strength produces an increase in the number of turns but does not induce the disappearance of the orientation movement. The body movement is always preceded by the head-movement. Haloperidol administration induces a dose-related increase of the orientation component of the motor pattern. These data together with others in the literature suggest the participation of the SNpc in the mechanism of shift in the focus of attention from one point to another in the contralateral surrounding environment.

The influence of dopaminergic A10 neurons on the motor pattern evoked by substantia nigra (pars compacta) stimulation.

The influence of the mesolimbic-mesocortical dopaminergic (DA) system on the motor pattern evoked by substantia nigra pars compacta (SNpc) stimulation was studied. Electrical stimulation of the A10 group of neurons caused an inhibitory effect preferentially directed towards the orientation movement. Sulpiride administration at low dosages (50 mg/kg i.p.) did not modify this movement at the basal condition, but abolished the increase of its duration induced by ventral tegmental area (VTA) co-stimulation. Mesolimbic activation opposes the effects of SNpc stimulation, restraining the animal in its antero-posterior axis by means of orientation movement inhibition. The results suggest a role of the DA mesolimbic-mesocortical system in the maintenance of focused attention.

Facilitatory effect of ventral tegmental area A10 region on the attack behaviour in the cat: possible dopaminergic role in selective attention.

Lateral hypothalamus (LH) stimulation in cats which do not spontaneously attack rats, produces an attack pattern which may be divided into 3 main stages: the first, defined as exploratory time (ET), begins with an environmental search and culminates in orienting towards the prey; in the second, defined as attack time (AT), the cat stalks the rat; the last is the biting stage in which the cat seizes and kills the prey by biting its head and neck. The effects of ventral tegmental area (VTA) stimulation on the latency of the whole sequence and on the different stages of the attack pattern were studied. VTA activation resulted in a significant decrease of biting latency, due to the reduction of exploratory time. Moreover, a significant period of prey fixation, seldom present during LH stimulation alone, was observed after VTA-LH co-stimulation. Sulpiride injection caused the disappearance of VTA effects on the predatory pattern. The results indicate that VTA activation induces a decrease in behaviour related to exploration of the environment, and an increase in the focusing of attention on the prey, which seems an important component in the regulation of the predatory pattern. Pharmacological evidence indicates that the VTA effect is mediated by the mesolimbic-mesocortical dopaminergic (DA) system.

Inhibitory effect of the ventral tegmental A10 region on the hypothalamic defence reaction: evidence for a possible dopaminergic mediation.

The influence of A10 region neurons of the ventral tegmental area (VTA) on the defence reaction evoked by stimulation of the ventromedial hypothalamic nucleus (VMH) was studied in the cat. The latency of the hissing in the defence reaction increased when the VTA was stimulated both ipsi- and contralaterally. A sulpiride (50mg/kg i.p.) injection totally abolished the VTA-provoked increase of the hissing latency without affecting the basal response.

Nalbufina vs dipirona en el alivio del dolor posamigdalectomía / Nalbutine vs dipyrone in the relief of post-tonsillectomy pain

A fin de valorar la eficacia de nalfubina versus dipirona para el alivio del dolor posamigdalectomía, se estudiaron 40 pacientes de uno u otro sexo, cuyas edades erna de 17 a 47 años. Estos pacientes se dividieron en dos grupos; ambos recibieron como parte de la medicación preanestésica 10 mg de diacepam y 0.5 mg de sulfato de atropina por vía intramuscular. En ambos grupos se registró la presión arterial, frecuencia cardiaca y respiratoria. El acto quirúrgico duró de 30 a 40 minutos y las intervenciones fueron llevada a cabo sin complicaciones. Los resultados demuestran que el efecto analgésico de nalbufina fue superior al de dipirona; asimismo, se comprobó que al administrar nalbufina no se presentaron efectos analgésicos de nalbufina fue superior al de dipirona; asimismo, se comprobó que al administrar nalbufina no se presentaron efectos indesables

Stimulation of the ventral tegmental area (A10 region) enhances the hypothalamic attack behavior in the cat.

The influence of the A10 region of the ventral tegmental area (VTA) on the quiet biting attack evoked by stimulation of the lateral hypothalamic nucleus (LH) was studied. The latency of the biting was considered as reference value and measured with stop-watches; it remained constant when hypothalamic stimulation was performed with the same parameters. Simultaneous activation of the A10 neuron group induced a facilitation of the aggression in the form of a decrease in the biting latency or a display of the attack pattern when LH was stimulated with parameters below the threshold for biting appearance. The facilitatory effect of the A10 neurons of the VTA is discussed.

Effects of substantia nigra stimulation on hypothalamic rage reaction in cats.

The effects of substantia nigra (SN) (pars compacta) stimulation on the rage reaction elicited by ventromedial hypothalamic nucleus (VMH) were investigated in the cat. The studied parameters of the rage reaction were: the current and the frequency threshold for the appearance of the hissing and the hissing latency. A facilitatory effect induced by the SN on the hypothalamic rage reaction was observed in the form of a decrease in the hypothalamic stimulus threshold for the hissing appearance and a decrease in the hissing latency. Moreover, when the VMH was stimulated with parameters below the threshold for the hissing display, simultaneous nigral activation determined its appearance. The excitatory influence exerted by the SN on the affective component of the aggressive behavior is discussed.