Fatal cases involving new psychoactive substances and trends in analytical techniques.

New psychoactive substances (NPS) are an emerging public health issue and deaths are commonly associated with polydrug abuse. Moreover, the number of new substances available is constantly increasing, causing intoxications in low doses, characteristics that impose to toxicology and forensic laboratories to keep routine methods up to date, with high detectability and constantly acquiring new analytical standards. Likewise, NPS metabolites and respective elimination pathways are usually unknown, making it difficult the detection and confirmation of the drug involved in the fatal case in an analytical routine. A literature search was performed on PubMed, Scopus and Web of Science databases for papers related to chromatographic analyses from fatal cases related to NPS use published from 2016 to 2021. A total of 96 papers were retrieved and reviewed in this study. Opioids, synthetic cathinones, phenethylamines/amphetamines and cannabinoids were the NPS classes most found in the fatal cases. In many cases, multiple compounds were detected in the biological samples, including prescription and other illegal drugs. Liquid chromatography-tandem mass spectrometry, an alternative to overcome the gas chromatography-mass spectrometry limitations for some compounds, was the analytical technique most used in the studies, and high resolution mass spectrometry was often applied to NPS metabolite investigation and structural characterization and identification of unknown compounds. Toxicological screening and quantitation methods need to be continuously updated to include new substances that are emerging on the drug market that can be fatal at very low doses.

Levels and Norm-Development: A Phenomenological Approach to Enactive-Ecological Norms of Action and Perception.

The enactive approach and the skilled intentionality framework are two closely related forms of radical embodied cognition that nonetheless exhibit important differences. In this paper, I focus on a conceptual disparity regarding the normative character of action and perception. Whereas the skilled intentionality framework describes the norms of action and perception as the capacity of embodied agents to become attuned (i.e., skilled intentionality) to preestablished normative frameworks (i.e., situated normativity), the enactive approach describes the same phenomenon as the enactment of norms (i.e., as sense-making) at different levels of organization that go from individual biological agents to linguistic encounters. I will argue that although both accounts accurately recognize important features of the norms of action and perception, they also have significant shortcomings. Norm-attunement accurately sees normative, ecological frameworks as the necessary set of constraints for the existence of norms at play in sociocultural bodily practices, but it fails to acknowledge the temporal and open-ended character of these norms and frameworks. Norm-enactment, by contrast, acknowledges that norms of action and perception are temporally open-ended, but fails to explicitly recognize that environmental normative frameworks are necessary for the enactment and development of all sort of norms in the interactional domain of an agent-environment system. To overcome these problems, I propose an enactive-ecological approach to norms of action and perception. This approach consists in describing norm-enactment as a result of a developmental process I call norm-development. This process describes the enactment of norms from the background of ecological, normative frameworks. These frameworks are norms enacted in the past of the interactional history of the agent-environment system that remain open to new configurations (new norms) in the present. To clarify conceptually norm-development, I appeal to Merleau-Ponty's descriptions of norms of perception, and more particularly to his concept of spatial levels. Like the enactive approach, Merleau-Ponty recognizes that perceptual norms emerge in the interactional history of the agent-environment system, but, like the skilled intentionality framework, he also posits that normative frameworks, that he calls levels, enable and constrain the emergence of perceptual norms and its development. Levels are therefore a phenomenological description of ecological normative frameworks that has been temporally constituted and that stay temporally open-ended as a fundamental requisite for the enactment and development of norms of action and perception.

Gene expression of Vibrio parahaemolyticus growing in laboratory isolation conditions compared to those common in its natural ocean environment.

BACKGROUND: Vibrio parahaemolyticus is an autochthonous marine bacterial species comprising strains able to grow in broth containing bile salts at 37 °C, a condition seldom found in the ocean. However, this condition is used for isolation in the laboratory because it is considered a necessary property for pathogenesis. In this context, revealing how gene expression enables V. parahaemolyticus to adapt to this particular condition -common to almost all V. parahaemolyticus isolates- will improve our understanding of the biology of this important pathogen. To determine the genes of V. parahaemolyticus differentially expressed when growing in isolation condition (37 °C, 0.9% NaCl, and 0.04% bile salts) referred to those at the temperature and salt concentration prevailing in ocean south of Chile (marine-like condition; 12 °C, 3% NaCl, and absence of bile salts) we used high-throughput sequencing of RNA. RESULTS: Our results showed that in the isolation condition, among the 5034 genes annotated in the V. parahaemolyticus RIMD2210633 genome, 344 were upregulated and 433 downregulated referred to the marine-like condition, managing an adjusted P-value (Padj) < E-5. Between the 50 more highly expressed genes, among the small RNAs (sRNA), the three carbon storage regulators B (CsrB) were up four to six times, while RyhB, related to iron metabolism besides motility control, was down about eight times. Among proteins, BfdA, a hemolysin-co-regulated protein (Hcp1) secreted by T6SS1, one of the most highly expressed genes, was about 140 times downregulated in isolation condition. The highest changes in relative expression were found among neighboring genes coding for proteins related to respiration, which were about 40 times upregulated. CONCLUSIONS: When V. parahaemolyticus is grown in conditions used for laboratory isolation 777 genes are up- or downregulated referred to conditions prevailing in the marine-like condition; the most significantly overrepresented categories among upregulated processes were those related to transport and localization, while secretion and pathogenesis were overrepresented among downregulated genes. Genes with the highest differential expression included the sRNAs CsrB and RhyB and the mRNAs related with secretion, nutritional upshift, respiration and rapid growing.

[Severe disseminated tuberculosis in a patient on immunosuppressive treatment. Report of one case]. / Sepsis tuberculosa gravissima. Una presentación infrecuente en paciente con tratamiento inmunosupresor.

Patients on immunosuppressive therapy are at increased risk of developing tuberculosis. We report a 39-year-old female with an ulcerative colitis receiving prednisone, azathioprine and azulfidine that was admitted to hospital due to fever, anemia, diarrhea and hematochezia. A chest CT scan showed multiple miliary micronodular images diffusely distributed and mediastinal enlarged lymph nodes with central necrosis, suggestive of disseminated tuberculosis. Antituberculous treatment was started but discontinued and the patient was treated as a bronchiolitis obliterans with methylprednisolone pulses and discharged. She was readmitted in shock one week later and died. After her death cultures for Mycobacterium tuberculosis were informed as positive. The clinical picture of the patient is known as sepsis tuberculosa gravissima.

Sepsis tuberculosa gravissima: Una presentación infrecuente en paciente con tratamiento inmunosupresor / Severe disseminated tuberculosis in a patient on immunosuppressive treatment: Report of one case

Patients on immunosuppressive therapy are at increased risk of developing tuberculosis. We report a 39-year-old female with an ulcerative colitis receiving prednisone, azathioprine and azulfidine that was admitted to hospital due to fever, anemia, diarrhea and hematochezia. A chest CT scan showed multiple miliary micronodular images diffusely distributed and mediastinal enlarged lymph nodes with central necrosis, suggestive of disseminated tuberculosis. Antituberculous treatment was started but discontinued and the patient was treated as a bronchiolitis obliterans with methylprednisolone pulses and discharged. She was readmitted in shock one week later and died. After her death cultures for Mycobacterium tuberculosis were informed as positive. The clinical picture of the patient is known as sepsis tuberculosa gravissima.

Erosion of lizard diversity by climate change and altered thermal niches.

It is predicted that climate change will cause species extinctions and distributional shifts in coming decades, but data to validate these predictions are relatively scarce. Here, we compare recent and historical surveys for 48 Mexican lizard species at 200 sites. Since 1975, 12% of local populations have gone extinct. We verified physiological models of extinction risk with observed local extinctions and extended projections worldwide. Since 1975, we estimate that 4% of local populations have gone extinct worldwide, but by 2080 local extinctions are projected to reach 39% worldwide, and species extinctions may reach 20%. Global extinction projections were validated with local extinctions observed from 1975 to 2009 for regional biotas on four other continents, suggesting that lizards have already crossed a threshold for extinctions caused by climate change.

Infarto renal: presentación de casos clínicos y revisión sistemática del diagnóstico y manejo / Renal infarction: report of clinical cases and comprehensive review of diagnosis and management

La isquemia renal aguda es un evento raro en la práctica clínica urológica. Su baja incidencia, así como lo inespecífico de sus manifestaciones clínicas, son habitualmente responsables de un diagnóstico tardío e incluso de errores diagnósticos, siendo sus síntomas atribuidos a entidades clínicas ciertamente más frecuentes. No existe consenso acerca del tratamiento en la literatura. Se describen manejos conservadores con terapia anticoagulante y medidas de apoyo, y hay quienes plantean alternativas más invasivas como la trombolisis intraarterial e incluso cirugía abierta. Se presentan cuatro casos de infarto renal y una revisión sistemática de la literatura, incorporando elementos de diagnóstico tanto de laboratorio como de imágenes, aspectos terapéuticos y pronósticos.

Renal infarction is a rare event in current clinical practice. The low incidence as well as the low specificity of its clinical manifestations are the main reasons for delayed or wrong diagnoses. There is no consensus in the literature concerning the treatment. Anticoagulant therapy, intra-arterial thrombolysis and surgery are the main approaches. Four cases and a systematic review of the literature on diagnosis and treatment of renal infarction are presented.

Estado nutricional del lactante hospitalizado por patología respiratoria y digestiva: estudo prospectivo / Nutritional status of the hospitalized infant from respiratory and digestive pathology: prospective study

Se estudiaron prospectivamente, desde un punto de vista antropométrico, aporte energético y apetencia, 186 lactantes hospitalizados por patología respiratoria (grupo R) y digestiva (grupo D), para valorar estado nutricional y sus cambios de ingreso al alta, establecer predictores de duración de la internación, medir prevalencia e incidencia de desnutrición, relacionar estado nutricional con enfermedades asociadas e intercurrencias, duración de la hospitalización con cambios antropométricos y precisar aporte energético y apetencia. Se verificó: 1) ambos grupos deterioraron su estado nutricional, excepto talla en R. 2) La prevalencia de desnutrición aguda fue 22.9% en R y 55.2% en D (p < 0.05), con incidencia respectiva de 3.6% y 4.6%. La prevalencia de desnutrición crónica fue 12.2% en R vs 22.9% en D (p <0.05). La incidencia en éste fue 3.4%. 3) En D, correlacionaron área magra braquial/edad,peso/edad,peso/talla y talla/edad al ingreso, con duración de la hospitalización. 4) No hubo relación entre el estado nutricional al ingreso y diagnósticos asociados e intercurrencias. 5) La duración de la internación correlacionó con deteriorio de casi todas las variables y especialmente grasa total y área grasa braquial/edad en D. 6) El aporte energético, aunque bajo al ingreso, fue superior en R y comparable al estándar al egreso. La apetencia fue similar en ambos grupos, mejoró más rápido en R, pero una proporción parecida de niños persistió con anorexia al alta