Cerebrospinal fluid closing pressure-guided tap test for the diagnosis of idiopathic normal pressure hydrocephalus: A descriptive cross-sectional study.

BACKGROUND: Tap test improves symptoms of idiopathic normal pressure hydrocephalus (iNPH); hence, it is widely used as a diagnostic procedure. However, it has a low sensitivity and there is no consensus on the parameters that should be used nor the volume to be extracted. We propose draining cerebrospinal fluid (CSF) during tap test until a closing pressure of 0 cm H2O is reached as a standard practice. We use this method with all our patients at our clinic. METHODS: This is a descriptive cross-sectional study where all patients with presumptive diagnosis of iNPH from January 2014 to December 2019 were included in the study. We used a univariate descriptive analysis and stratified analysis to compare the opening pressure and the volume of CSF extracted during the lumbar puncture, between patients in whom a diagnosis of iNPH was confirmed and those in which it was discarded. RESULTS: A total of 92 patients were included in the study. The mean age at the time of presentation was 79.4 years and 63 patients were male. The diagnosis of iNPH was confirmed in 73.9% patients. The mean opening pressure was 14.4 cm H2O mean volume of CSF extracted was 43.4 mL. CONCLUSION: CSF extraction guided by a closing pressure of 0 cm H2O instead of tap test with a fixed volume of CSF alone may be an effective method of optimizing iNPH symptomatic improvement and diagnosis.

Catabolism of phenylacetic acid in Penicillium rubens. Proteome-wide analysis in response to the benzylpenicillin side chain precursor.

Biosynthesis of benzylpenicillin in filamentous fungi (e.g. Penicillium chrysogenum - renamed as Penicillium rubens- and Aspergillus nidulans) depends on the addition of CoA-activated forms of phenylacetic acid to isopenicillin N. Phenylacetic acid is also detoxified by means of the homogentisate pathway, which begins with the hydroxylation of phenylacetic acid to 2-hydroxyphenylacetate in a reaction catalysed by the pahA-encoded phenylacetate hydroxylase. This catabolic step has been tested in three different penicillin-producing strains of P. rubens (P. notatum, P. chrysogenum NRRL 1951 and P. chrysogenum Wisconsin 54-1255) in the presence of sucrose and lactose as non-repressing carbon sources. P. chrysogenum Wisconsin 54-1255 was able to accumulate 2-hydroxyphenylacetate at late culture times. Analysis of the P. rubens genome showed the presence of several PahA homologs, but only Pc16g01770 was transcribed under penicillin production conditions. Gene knock-down experiments indicated that the protein encoded by Pc16g01770 seems to have residual activity in phenylacetic acid degradation, this catabolic activity having no effect on benzylpenicillin biosynthesis. Proteome-wide analysis of the Wisconsin 54-1255 strain in response to phenylacetic acid revealed that this molecule has a positive effect on some proteins directly related to the benzylpenicillin biosynthetic pathway, the synthesis of amino acid precursors and other important metabolic processes. SIGNIFICANCE: The adaptive response of Penicillium rubens to benzylpenicillin production conditions remains to be fully elucidated. This article provides important information about the molecular mechanisms interconnected with phenylacetate (benzylpenicillin side chain precursor) utilization and penicillin biosynthesis, and will contribute to the understanding of the complex physiology and adaptation mechanisms triggered by P. rubens (P. chrysogenum Wisconsin 54-1255) under benzylpenicillin production conditions.

Recuperación del funcionamiento hidrológico de ecosistemas de páramo en colombia / Rehabilitation of hydrological functioning of páramo ecosystems in colombia

Los páramos son ecosistemas que se caracterizan por una alta humedad relativa, alta frecuencia de niebla y por tener una vegetación arbustiva y herbácea, adaptada a las condiciones de alta montaña. En condiciones naturales estos ecosistemas presentan una oferta hídrica alta, entre otros servicios ecosistémicos; sin embargo, esto cambia cuando son degradados. A pesar de su importancia son ecosistemas que han sido modificados por el hombre, la mayoría aún sin haber sido estudiados. Este documento presenta los resultados de una investigación realizada en tres páramos en Colombia, en la cual, se evalúa su funcionamiento hidrológico y la capacidad de recuperación, una vez han sido alterados; para esto, se estudió el clima, la hidrología y los suelos. Los resultados indican que estos ecosistemas tienen condiciones climáticas desiguales, que determinan su rendimiento y regulación hídrica; con diferencias en las propiedades hidrofísicas del suelo y contenido de materia orgánica, lo que determina diferencias en su capacidad para retener la humedad y la disponibilidad de agua para las plantas. Estos resultados indican que los páramos, con un grado bajo de disturbio, presentan un alto rendimiento y buena regulación hídrica; pero igual que los páramos intervenidos, recuperan el estado natural de las propiedades del suelo y, consecuentemente, su funcionamiento hidrológico, aún en pocas décadas.

Páramos are equatorial alpine ecosystems characterized by a high air humidity, frequency of fog and the presence of shrub and herbaceous vegetation adapted to the specific equatorial alpine conditions. Under natural conditions these ecosystems present a high water yield, among other ecosystem services, however, this changes when they are degraded. Despite their importance, they are ecosystems that have been modified by man, most of them even without having been studied. This paper presents the results of a hydrological research carried out in three páramos in Colombia, which evaluates their hydrological functioning and their capacity for recovery once they are altered. Therefore, we studied their climate, hydrology, and soils properties. Results indicate that these ecosystems have different climatic conditions, which determine their water yield and water regulation. Differences in the hydro-physical properties of soils and organic matter content, which determine differences in their capacity to retain water and on the magnitude of the water available for plants. These results indicate that undisturbed páramos or with a low degree of disturbance present high water yield and good water regulation; and intervened páramos can recover the natural conditions of soil properties, and consequently their hydrological functioning, even in a few decades.

Cerebral haemorrhage as a clinical manifestation of human ehrlichiosis.

A 16-year-old young man presented to the emergency room with new-onset generalised tonic-clonic seizures. Examination showed a Glasgow score of 13 and predominantly crural left hemiparesis. Imaging demonstrated a right frontoparietal haemorrhage of non-vascular origin with perilesional oedema. Surgical drainage was carried out, but rebleeding occurred within 24 hours following surgery, and again 1 week after discharge. On reinterrogation and examination, Ehrlichia canis infection was suspected and empirical management with doxycycline was begun. Improvement was evident 72 hours after antibiotic initiation, and PCR confirmed the diagnosis; thus, doxycycline was continued for 6 months. After 2 years, seizures recurred and treatment was reinstated with good clinical response. However, seizures reappeared whenever treatment discontinuation was attempted. Lacking alternatives, doxycycline was maintained up to the third year following the initial episode. Subsequently, the patient showed complete resolution without neurological sequelae up to his last follow-up visit, 12 months following treatment cessation.