Warming and redistribution of nitrogen inputs drive an increase in terrestrial nitrous oxide emission factor.

Anthropogenic nitrogen inputs cause major negative environmental impacts, including emissions of the important greenhouse gas N2O. Despite their importance, shifts in terrestrial N loss pathways driven by global change are highly uncertain. Here we present a coupled soil-atmosphere isotope model (IsoTONE) to quantify terrestrial N losses and N2O emission factors from 1850-2020. We find that N inputs from atmospheric deposition caused 51% of anthropogenic N2O emissions from soils in 2020. The mean effective global emission factor for N2O was 4.3 ± 0.3% in 2020 (weighted by N inputs), much higher than the surface area-weighted mean (1.1 ± 0.1%). Climate change and spatial redistribution of fertilisation N inputs have driven an increase in global emission factor over the past century, which accounts for 18% of the anthropogenic soil flux in 2020. Predicted increases in fertilisation in emerging economies will accelerate N2O-driven climate warming in coming decades, unless targeted mitigation measures are introduced.

[CHAOS in neonatal emergency care? : Tracheal agenesis in the obstetric theatre]. / CHAOS bei der Neugeborenenversorgung? : Die Trachealagenesie im Sectio-OP.

Tracheal agenesis (TA) is a very rare congenital malformation of unknown aetiology. It is often associated with polymalformative syndromes; the neonates commonly present a critical condition during post-natal treatment. Pathology revolves around the triad of aphonia, respiratory distress syndrome and impossibility of endotracheal intubation. In contrast to the most important differential diagnosis, i. e., congenital high airway obstruction syndrome (CHAOS), surgical airway management is also impossible due to the absence of tracheal structures. In most cases, prognosis is very poor. The case report at hand portrays the treatment of a neonate suffering from tracheal agenesis.

Diagnóstico de infección por VIH por el hallazgo incidental de alteraciones ultraestructurales en una biopsia renal: Report of one case / Ultrastructural alterations in renal biopsy leading to the diagnosis of HIV infection

HIV infection has different clinical presentations. We report a 21-year-old male with longstanding isolated microscopic hematuria attributed to thin glomerular basement membrane disease, who after 15 years of follow-up presented with significant proteinuria. A kidney biopsy was performed, revealing the presence of tubulo-reticular inclusions in the glomerular endothelial cells. This finding led to suspect an HIV infection, which was verified. Antiretroviral therapy, angiotensin-converting enzyme and angiotensin II receptor blockers were prescribed. At 6 years of diagnosis the patient is asymptomatic and has normal kidney function. Microscopic hematuria and low level proteinuria persists.

[Ultrastructural alterations in renal biopsy leading to the diagnosis of HIV infection]. / Diagnóstico de infección por VIH por el hallazgo incidental de alteraciones ultraestructurales en una biopsia renal: Report of one case.

HIV infection has different clinical presentations. We report a 21-year-old male with longstanding isolated microscopic hematuria attributed to thin glomerular basement membrane disease, who after 15 years of follow-up presented with significant proteinuria. A kidney biopsy was performed, revealing the presence of tubulo-reticular inclusions in the glomerular endothelial cells. This finding led to suspect an HIV infection, which was verified. Antiretroviral therapy, angiotensin-converting enzyme and angiotensin II receptor blockers were prescribed. At 6 years of diagnosis the patient is asymptomatic and has normal kidney function. Microscopic hematuria and low level proteinuria persists.

[Granulicatella spp]. / Granulicatella spp.

Granulicatella spp. is a bacteria of the oral cavity, belonging to the nutritionally variant group streptococci, and has been identified in 5% of all bacterial endocarditis. It's an important etiologic species in endocarditis, particularly in the setting of negative blood cultures. Granulicatella is a non-mobile, non- spore forming organism that is both catalase and oxidase negative. The treatment for Granulicatella, is the same for Enterococcus according to the American and European guidelines, however resistance to this treatment has been reported.

Enfermedad por depósito de cristales de pirofosfato de calcio como ejemplo de forma de manifestación de la enfermedad en el adulto mayor / Calcium pyrophosphate dihydrate crystal deposition disease as an example of illness presentation in the elderly

Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state. The patient was discharged 13 days after admission in good conditions.

Fiebre de Chikungunya: reporte de tres casos del Hospital Naval Almirante Nef / Chikungunya fever: report of three cases from Almirante Nef Naval Hospital

Chikungunya fever is an emerging infection in our country due to travelers to endemic areas. It presents acutely with high fever, fatigue, headache, myalgia, skin rash and arthritis, usually as a symmetric polyarthritis compromising the interphalangeal and metacarpophalangeal joints, wrist, elbow, ankle and knee. While most of the symptoms last about a week, arthralgias may become chronic and generate significant functional impairment. Chikungunya has been postulated as a triggering factor for rheumatoid arthritis because of the presence of positive rheumatoid factor. We present the three confirmed cases in Almirante Nef Naval Hospital with the review of the published literature...

La fiebre de Chikungunya es una infección novedosa en nuestro país pues su contagio se produce por viajeros en zonas endémicas. Se presenta generalmente en forma aguda con fiebre alta, astenia, cefalea, mialgia, rash cutaneo y artritis, mayoritariamente como poliartritis simétrica comprometiendo las articulaciones interfalángicas, metacarpofalángicas, muñecas, codos, tobillo y rodillas. Si bien la mayoría de los síntomas duran aproximadamente una semana, las artralgias pueden hacerse crónicas y generar un importante deterioro funcional. Se ha postulado que podría ser un factor gatillante de artritis reumatoide ante la presencia de factor reumatoideo positivo. A continuación se presentan los tres casos confirmados del Hospital Naval Almirante Nef junto a la revisión de la literatura publicada hasta el momento...

[Cryptosporidium species in immunodeficient and immunocompetent patients of Valparaíso: a descriptive study]. / Especies de Cryptosporidum en pacientes inmunodeficientes e inmunocompetentes de Valparaíso: Estudio descriptivo.

OBJECTIVE: Genetical characterization of human Cryptosporidium isolates to determine species diversity. PATIENTS AND METHODS: A cross-sectional study in Valparaiso, Chile, was performed. A total of 458 patients participated in the study: 259 immunodeficient (HIV, cancer, renal transplant hyper-IgM syndrome, HIV and unintended pregnancy) and 178 immunocompetent individuals provided stool samples and 21 patients bile samples. RESULTS: We obtained 29 (6.3%) positive samples. 25 (9.7%) derived from immunodeficient patients: 18 (7.3%) from HIV patients and 7 from patients with other immunodeficiencies. The remaining 4 (2.2%) samples originated from immunocompetent individuals. Cryptosporidium genotyping was performed by nested polymerase chain reaction (PCR) and restriction fragments length polymorphism and/or PCR followed by sequencing of the SSU rRNA from oocysts in stool samples. 4 species were identified: C. parvum, C. hominis, C. muris, and C. meleagridis. In immunodeficient patients, 16 C. parvum, 8 C. hominis, and 1 C. muris strain were identified. In immunocompetent participants, 3 C. hominis and 1 C. meleagridis isolate were found. CONCLUSION: The results indicate that zoonotic and anthroponotic transmission occurs and that C. parvum is the predominant species in our study population. Cryptosporidium species of zoonotic transmission accounted for 62% of the human infections detected in this study.

Especies de Cryptosporidum en pacientes inmunodeficientes e inmunocompetentes de Valparaíso: Estudio descriptivo / Cryptosporidium species in immunodeficient and immunocompetent patients of Valparaíso: A descriptive study

Objective: Genetical characterization of human Cryptosporidium isolates to determine species diversity. Patients and Methods: A cross-sectional study in Valparaiso, Chile, was performed. A total of 458 patients participated in the study: 259 immunodeficient (HIV, cancer, renal transplant hyper-IgM syndrome, HIV and unintended pregnancy) and 178 immunocompetent individuals provided stool samples and 21 patients bile samples. Results: We obtained 29 (6.3%) positive samples. 25 (9.7%) derived from immunodeficient patients: 18 (7.3%) from HIV patients and 7 from patients with other immunodeficiencies. The remaining 4 (2.2%) samples originated from immunocompetent individuals. Cryptosporidium genotyping was performed by nested polymerase chain reaction (PCR) and restriction fragments length polymorphism and/or PCR followed by sequencing of the SSU rRNA from oocysts in stool samples. 4 species were identified: C. parvum, C. hominis, C. muris, and C. meleagridis. In immunodeficient patients, 16 C. parvum, 8 C. hominis, and 1 C. muris strain were identified. In immunocompetent participants, 3 C. hominis and 1 C. meleagridis isolate were found. Conclusion: The results indicate that zoonotic and anthroponotic transmission occurs and that C. parvum is the predominant species in our study population. Cryptosporidium species of zoonotic transmission accounted for 62% of the human infections detected in this study.

Objetivo: Caracterizar genéticamente Cryptosporidium spp para determinar la diversidad de especies en seres humanos. Pacientes y Métodos: estudio transversal realizado en Valparaíso, Chile, Un total de 458 pacientes participaron del estudio; 259 inmunodeficientes (pacientes con infección por VIH, oncológicos, con trasplante renal, síndrome de hiper IgM y una mujer embarazada sin infección por VIH) y 178 inmunocompetentes proporcionaron muestras fecales y 21 muestras de bilis. Resultados: Se obtuvieron 29 (6,3%) muestras positivas; 25 (9,7%) de inmunodeficientes: 18 (7,3%) de pacientes con infección por VIH y 7 con otras inmunodeficiencias; los restantes 4 (2,2%) fueron de personas inmunocompetentes. La genotipificación de Cryptosporidium se efectuó mediante reacción de polimerasa en cadena (RPC) anidada y el polimorfismo de la longitud de los fragmentos de restricción y/o RPC - secuenciación de la SSU ARNr, a partir de ooquistes en la muestra fecal. Se identificaron 4 especies: C. parvum, C. hominis, C. muris y C. meleagridis. En pacientes inmunodeficientes, se caracterizaron 16 C. parvum, 8 C. hominis y un C. muris; en inmunocompetentes: 3 C. hominis y un C. meleagridis. Conclusión: Los resultados indican que se produce transmisión zoonótica y antroponótica y que C. parvum es la especie predominante en este estudio. Las especies de Cryptosporidium de transmisión zoonótica representan el 62% en los seres humanos participantes de este estudio.

[Isospora belli infection in HIV positive patients: report of two cases and literature review]. / Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura.

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases of Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura / Isospora belli infection in HIV positive patients: report of two cases and literature review

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases oí Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

La isosporosis es una infección parasitaria provocada por protozoos del género Isospora, coccidio que afecta con diversas especies a diferentes vertebrados, entre los que se encuentra el ser humano. Es una infección poco frecuente en nuestro país y no constituye una zoonosis. Se presentan dos casos con infección por Isospora belli en pacientes infectados con el virus de inmunodeficiencia humana procedentes de la Región de Valparaíso. Se analizan las manifestaciones producidas por este agente, la epidemiología de la infección, los casos publicados en la literatura nacional e internacional, así como su tratamiento y las medidas de prevención.

[Tungiasis affects a chilean turist]. / Tungiasis afecta a un turista chileno.

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan Africa, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

Tungiasis afecta a un turista chileno / Tungiasis affects a chilean turist

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan África, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

La tungiasis es una ectoparasitosis cutánea producida por la hembra de la pulga de arena Tunga penetrans, cuya mayor prevalencia ocurre en África Sub-sahariana, Sudamérica y el Caribe. Comunicamos el caso de un chileno de 23 años que viajó a Brasil y que a su regreso presentó lesiones dérmicas sugerentes de tungiasis. El diagnóstico fue confirmado por una biopsia identificando el artrópodo y un huevo en una de las lesiones. Se revisa la historia natural, las co-morbilidades asociadas y alternativas de tratamiento.

Inner-valence photoionization of O((1)D): experimental evidence for the 2s(2)2p(4)((1)D)-->2s(1)2p(5)((1)P) transition.

Photoionization and autoionization of electronically excited atomic oxygen O((1)D) are investigated in the energy range between 12 and 26 eV using tunable laser-produced plasma radiation in combination with time-of-flight mass spectrometry. A broad, asymmetric, and intense feature is observed that is peaking at 20.53+/-0.05 eV. It is assigned to the 2s(2)2p(4)((1)D)-->2s(1)2p(5)((1)P) transition, which subsequently autoionizes by a Coster-Kronig transition, as predicted by the previous theoretical work [K. L. Bell et al., J. Phys. B 22, 3197 (1989)]. Specifically, the energy of the unperturbed transition occurs at 20.35+/-0.07 eV. Its shape is described by a Fano profile revealing a q parameter of 4.25+/-0.8 and a width of gamma=2.2+/-0.15 eV. Absolute photoionization cross section sigma is derived, yielding sigma=22.5+/-2.3 Mb at the maximum of the resonance. In addition, weak contributions to the O((1)D) yield from dissociative ionization originating from molecular singlet oxygen [O(2)((1)Delta(g))] are identified as well. Possible applications of the 2s(2)2p(4)((1)D)-->2s(1)2p(5)((1)P) transition as a state-selective and sensitive probe of excited oxygen in combination with photoionization mass spectrometry are briefly discussed.

Reportes clínicos: infección probada por Aspergillus flavus y probable infección pulmonar por Emericella nidulans en pacientes inmunodeprimidos / Clinical reports: tested rhinosinusal infection by Aspergillus flavus and probable pulmonary infection by Emericella nidulans in immunodepressed patients

En los últimos 20 años la incidencia de aspergilosis invasiva ha aumentado entre 5 y 10 veces, presentando una mortalidad que varía desde un 60 a 98 por ciento dependiendo de su localización, enfermedad de base (inmunodepresión), diagnóstico y tratamiento precoz. A pesar que se ha logrado un importante avance en estos dos últimos decenios, aproximadamente un 50 por ciento de los casos se diagnostican post mortem. Se reportan dos casos de aspergilosis (probada y probable) en pacientes inmunodeprimidos de 21 y 44 años respectivamente. El primer caso corresponde a una infección rinosinusal en una paciente con leucemia linfoblástica, con un cuadro clínico caracterizado por aumento de volumen facial izquierdo, compromiso progresivo del estado general y equimosis en región periorbitaria. La endoscopia nasal detectó abundante secreción y tejido friable amarillento sugerente de infección micótica. Las muestras de tejidos enviadas al laboratorio para examen directo y cultivos arrojaron presencia de hifas en la mucosa y crecimiento abundante de Aspergillus flavus. Se inició terapia con itraconazol, cambiándose posteriormente a voriconazol, con respuesta favorable y disminución del dolor y volumen facial. Sin embargo, la paciente fallece al 10º día del ingreso debido a su mal estado general, avance de la falla medular y posterior insuficiencia respiratoria. El segundo caso corresponde a una probable infección pulmonar en una paciente con cáncer de mama en tratamiento quimioterápico. La paciente ingresó con el diagnóstico de neutropenia febril y probable neumonía de etiología bacteriana, fue tratada con antimicrobianos tanto en el hospital comunal como en el de base. Sin embargo, presentó una evolución tórpida, cursando posteriormente con hemoptisis, insuficiencia respiratoria y compromiso de conciencia. Se tomaron muestras de secreción endotraqueal las que fueron enviadas para estudio bacteriológico(TBC) y micológico, además de hemo y urocultivos. Los resultados de los...

In the lately twenty years the incidence of invasive spergillosis has increased five and ten times, causing a mortality rate ranging from 60 to 98 percent, depending on its location, nature of disease (immunodepression), diagnosis and forward treatment. In spite of the fact that there has been a significant progress in this lately period of twenty years, about 50 percent of cases were detected post mortem. Two cases of spergillosis (tested and probable) in 21 and 44 aged immunodepressed patients respectively are herein reported. The first case involves a rhinosinusal infection in a female patient diagnosed with lymphoblastic leukemia, whose clinical symptoms were an increase in the left volume of her face, a progressivecompromise in her overall state of health and ecchymosis in her periorbitary region. Nasal endoscopy revealed abundant secretion and yellowish friable tissues which suggested a mycotic infection. Samples of tissues sent to the lab for direct exam and cultures revealed the presenceof hypha in the mucus and an abundant growth of Aspergillus flavus. The first therapy was with itraconazol, changing later on to voriconazol what resulted in adecrease of pain and face volume. However, the patient dies on the tenth day of her ingress due to her bad state ofhealth, progress in glandular failure and ultimate respiratory insufficiency. The second case involves a probable pulmonary infection in a patient diagnosed with breast cancer and receiving chemotherapy treatment. She was ingressed with a febrile neutropenia and a probable bacterial etiology pneumonia and she was treated with antimicrobial medication both in the community hospital and in the base building. However, she showed a torpid evolution followed furthermore by hemoptisis, respiratory insufficiencyand consciousness compromise. Samples of endotraqueal secretion were taken in order to submit them to bacteriological and mycological (TBC) studies, together with hemo...

Outcomes from television sets toppling onto toddlers.

OBJECTIVE: To assess outcomes of trauma caused by television sets falling onto children. METHODS: Retrospective review of medical charts of 183 children aged 7 years and younger hospitalized for injuries caused by falling television sets. Descriptive statistics were applied. DATA SOURCES: Phase 2 (1988-1995) and phase 3 (1995-1999) of the National Pediatric Trauma Registry. OUTCOME MEASURES: Demographics, injured body region, injury severity measured by the Injury Severity Score, length of hospital stay, admission to the intensive care unit, surgical intervention, in-hospital death rate, disability resulting from the injury, and disposition at discharge from the hospital. RESULTS: The sample population represented 0.5% of all National Pediatric Trauma Registry admissions in this age group. More than half (57.4%) of the children were boys, and more than three quarters (76.0%) were 1 to 4 years of age. In most cases (95.1%), the injury occurred at home. Most children (68.3%) sustained head injury, and 43.7% sustained injuries to multiple body regions. More than a quarter (28.4%) of the children had injuries of moderate to critical severity (Injury Severity Score, 10-75), about a third (31.1%) required admission to the intensive care unit, and 20.2% needed 1 or more surgical interventions. The average length of hospitalization was 3.3 days. Five children (2.7%) died, and 48 (26.2%) developed functional limitations, which required discharge to a rehabilitation facility in 5 cases. Most (94.0%) of the children returned to their home. The proportion of television set-related injuries increased more than 100% during the study period. CONCLUSIONS: The injuries reported are not trivial. Not only did they require hospitalization, but they also resulted in an in-hospital death rate comparable to the 2.5% rate observed in children of the same age group injured by unintentional blunt trauma, inclusive of motor vehicle traffic-related injuries. Since virtually all American children are at risk for such injury, we suggest that television set designs be modified to reduce the incidence and severity of the problem.

Ultrasound in the diagnosis of fractures in children.

We compared the results of primary ultrasonographic examination of 163 children with 224 suspected fractures with the subsequent radiological findings. The aim was to assess the value of ultrasound in the diagnosis of fractures in children. We found a good correlation for fractures of the long bones of the upper and lower limbs. Ultrasound was most reliable for the detection of simple femoral and humeral diaphyseal fractures and fractures of the forearm. It was less dependable for compound injuries and fractures adjacent to joints, lesions of the small bones of the hand and foot, non-displaced epiphyseal fractures (Salter-Harris type 1) or those with a fracture line of less than 1mm. We were able to distinguish several types of fracture in which the use of ultrasound alone gave reliable information and further radiography was unnecessary. We discuss the advantages and disadvantages of skeletal ultrasonographic studies in children.

Injuries to children with attention deficit hyperactivity disorder.

OBJECTIVES: To determine differences between hospital admitted injuries to children with preinjury attention deficit hyperactivity disorder (ADHD) and injuries to those with no preinjury conditions (NO). DESIGN: Comparative analysis, excluding fatalities, of ADHD patients (n = 240) to NO patients (n = 21 902), 5 through 14 years of age. OUTCOME MEASURES: Demographics, injury characteristics, length of stay, admission to the intensive care unit, surgical intervention, disability, and disposition at discharge. DATA SOURCE: Retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996. RESULTS: Compared with the NO children, the children with ADHD were more likely to be boys (87.9% vs 66.5%), to be injured as pedestrians (27.5% vs 18.3%) or bicyclists (17.1% vs 13.8%), and to inflict injury to themselves (1.3% vs 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs 43%), to sustain head injuries (53% vs 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs 5.4%) and the Glasgow Coma Scale (7.5% vs 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the NO group. In both groups, 40% had surgery, but the ADHD children were admitted more frequently to the intensive care unit (37.1% vs 24.1%). The injury led to disability in 53% of the children with ADHD vs 48% of the NO children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the NO children. CONCLUSIONS: Injured children with ADHD are more likely to sustain severe injuries than are children without ADHD. More research is needed to identify prevention efforts specifically targeted at this population.

[Effect of endoscopic surgery techniques in children on ventilation]. / Auswirkungen endoskopischer Operationstechniken bei Kindern auf die Beatmung.

The purpose of our study was to show the effects of laparoscopic procedures on the ventilation of children. We measured an increase of ventilation pressures (Pmax, Ppfat and Pmean) of 28, 35 and 48% respectively. petCO2 rose from 35 to 41 +/- 2 mmHg. There was no loss of body temperature in any child. Laparoscopic procedures as seen here for appendectomy or diagnostic exploration in children of 13.5 kg body weight or more caused no problems that were clinically evident. The increase of ventilation pressure could be attenuated by choosing the parameters of ventilation (e.g. flow, I:E ratio) in such a way that Pmax does not exceed 20 mbar. Alternatively, pressure-controlled ventilation may be used, adjusting petCO2 by ventilation frequency. In any case there must be a strict control of all possible side effects of laparoscopy, such as cutaneous emphysema or pneumothorax.