Acquired hepatocerebral degeneration and hepatic encephalopathy: one or two entities?

BACKGROUND AND PURPOSE: Acquired hepatocerebral degeneration (AHD) and hepatic encephalopathy (HE) are neurological complications of chronic liver disease (CLD) with portosystemic shunt. While HE is common, AHD is a rare entity, and the clinical imaging relationships observed in small series lack validation in large patient cohorts. The aim of this study was to characterize a cohort of AHD patients and to explore possible associations with HE coexistence. METHODS: We performed a retrospective analysis of patients with a working AHD diagnosis, between 2008 and 2019. Clinical, laboratory, imaging and neuropsychological results at first neurological observation were reviewed and compared between the 'AHD' group and the 'AHD with HE' group. RESULTS: A total of 76 patients were recruited. The most frequent neurological manifestations were neuropsychiatric (93.4%) and extrapyramidal (84.2%). Only 38% of patients had hypermanganesemia. Compared with the AHD group, the AHD with HE group had more hyperkinetic movement disorders (71.4% vs. 38.5%; P = 0.05), a higher number of patients on the dementia spectrum (57.7% vs. 20%; P = 0.04), higher median ammonia levels (P = 0.014) and more widespread cortico-subcortical and pyramidal involvement on brain magnetic resonance imaging. Nineteen patients underwent liver transplantation, with significantly improved survival (P = 0.006). DISCUSSION: Hepatic encephalopathy and AHD often coexist in the same patient. Seventy-six patients with CLD and AHD were evaluated, making this one of the largest reported AHD cohorts. Blood manganese level was a weak diagnostic marker in AHD. Early liver function restoration through liver transplantation improved survival. Our report provides a detailed description of the phenotype and long-term outcome of AHD, with relevance for diagnosis and treatment.

[Results of antimicrobial susceptibility surveillance in Chile: consolidating a network]. / Resultados de la vigilancia de susceptibilidad antimicrobiana en Chile: Consolidando una red.

Antimicrobial resistance is an increasing public health issue. Creation of surveillance networks is a matter of major importance for antimicrobial resistance understanding and monitoring. Also, they contribute to design actions for controlling its appearance and dissemination. In 2007 a colaborative group in antimicrobial resistance was formed, representing several health institutions across the country. In this paper we report the results of 2009 surveillance with emphasis in its interpretation, limitations and future perspectives.

[23-valent pneumococcal vaccine. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010]. / Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010.

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysaccharide vaccine against invasive pneumococcal disease, non bacteraemic pneumococcal pneumonia, and probable pneumococcal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunity conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of pneumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

Chemical and structural analyses of titanium plates retrieved from patients.

The aim of this study was to evaluate the microscopic structure and chemical composition of titanium bone plates and screws retrieved from patients with a clinical indication and to relate the results to the clinical conditions associated with the removal of these devices. Osteosynthesis plates and screws retrieved from 30 patients between January 2010 and September 2013 were studied by metallographic, gas, and energy dispersive X-ray (EDX) analyses and the medical records of these patients were reviewed. Forty-eight plates and 238 screws were retrieved. The time elapsed between plate and screw insertion and removal ranged between 11 days and 10 years. Metallographic analysis revealed that all the plates were manufactured from commercially pure titanium (CP-Ti). The screw samples analyzed consisted of Ti-6Al-4V alloy, except four samples, which consisted of CP-Ti. Titanium plates studied by EDX analysis presented greater than 99.7% titanium by mass. On gas analysis of Ti-6Al-4V screws, three samples were outside the standard values. One CP-Ti screw sample and one plate sample also presented an oxygen analysis value above the standard. The results indicated that the physical properties and chemical compositions of the plates and screws did not correspond with the need to remove these devices or the time of retention.

Plasma catecholamines during an ultrarapid heroin detoxification.

The adrenergic system has long been known to be activated in a situation of stress and thus during opiate withdrawal. A method for detoxification that decreases the stimulation of the sympathetic nervous system will prevent changes of catecholamine levels. Some of such methods have been developed. One of them uses direct transition from heroin to oral naltrexone after deep sedation with midazolam in conjunction with naloxone, droperidol, ondansetron, and clonidine treatment for 24 hours. Can such method prevent adrenergic changes? Moreover, 5-HT has been related to mood disorders. This study aims to determine plasma catecholamines and 5-HT before heroin withdrawal, during the day of the withdrawal, and at the ends of the first day, the first week, and the first 6 months. Forty-three patients with more than 6 years of drug abuse volunteered to seek help to detoxify. After clinical evaluation, blood samples were taken. Plasma catecholamines were isolated by standard alumina procedures and measured by high-performance liquid chromatography with electrochemical detection. Only for NE was there a significant decrease in the day of heroin withdrawal with deep sedation, followed the next day by an increase. During the following days, NE plasma concentrations returned slowly to basal levels. Epinephrine and dopamine plasma levels did not significantly change. Platelet 5-HT levels progressively decreased from the day before detoxification until the last period of observation. We also found that there were no abrupt changes in cardiovascular functions. In conclusion, our results suggest that this type of ultrarapid opiate detoxification prevents the dramatic activation of the autonomic nervous system.

Resultados de la vigilancia de susceptibilidad antimicrobiana en Chile: Consolidando una red / Results of antimicrobial susceptibility surveillance in Chile: Consolidating a network

La resistencia antimicrobiana es un problema de salud pública en aumento. La generación de redes de vigilancia es una necesidad para la correcta comprensión y seguimiento de este fenómeno, además de ayudar a orientar las medidas para el control de su aparición y diseminación. En Chile, desde el año 2007 se constituyó un grupo colaborativo de resistencia antimicrobiana de centros de salud de varias regiones, que ha generado información respecto a la frecuencia de resistencia antimicrobiana de distintas especies bacterianas. En este artículo se presentan los resultados de la vigilancia del año 2009, con énfasis en su interpretación, limitaciones y perspectivas a futuro.

Antimicrobial resistance is an increasing public health issue. Creation of surveillance networks is a matter of major importance for antimicrobial resistance understanding and monitoring. Also, they contribute to design actions for controlling its appearance and dissemination. In 2007 a colaborative group in antimicrobial resistance was formed, representing several health institutions across the country. In this paper we report the results of 2009 surveillance with emphasis in its interpretation, limitations and future perspectives.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010 / 23-Valent Pneumococcal Vaccine: Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysacchar-die vaccine against invasive pneumococcal disease, non bacteriemic pneumococcal pneumonia, and probable pneumococal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunitty conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of penumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

El artículo resume los hallazgos de la evidencia científica en relación a la protección que confiere la vacuna neumocóccica polisacárida 23 valente contra la enfermedad neumocóccica invasora, las neumonías neumocóccicas no bacteriémicas y las neumonías probablemente de etiología neumocóccica en el adulto mayor, estableciendo una categorización entre adultos mayores con factores de riesgo y sin ellos. Se documenta a la vez, el impacto que ha tenido la vacuna neumocóccica conjugada en la población infantil, en reducir las neumonías en el adulto mayor. Basados en la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, realiza recomendaciones sobre cuál sería la mejor forma de prevenir las enfermedades neumocóccicas en el adulto mayor.

Interaçäo de síndrome geral de adaptaçäo e miocardite causando ruptura ventricular em cisne negro (Cygnus atratus): relato de caso / Interaction of general adaptation syndrome and myocarditis causing ventricular rupture in a black swan (Cygnus atratus): case report

Relato de caso de interaçäo de miocardite crônica e Síndrome Geral de Adaptaçäo (estresse) causando ruptura da parede ventricular esquerda em uma fêmea jovem da espécie Cygnus atratus (cisne-negro), que veio a óbito no Zoológico Municipal de Taboäo da Serra, em Säo Paulo, durante período de quarentena, após longa viagem em condiçöes desfavoráveis de temperatura e ventilaçäo

Cinomose em canídeos e mustelídeos silvestres brasileiros: relato de caso / Distemper in Brazilian wild canidae and mustelidae: case report

Relatam-se cincos casos confirmados de cinomose de um total de 13 óbitos de animais silvestres brasileiros das espécies Galictis vittata, Crisocyon brachyurus e Cerdocyon thous, mantidos em cativeiro no Zoológico Municipal de Taboäo da Serra - SP - Brasil. A histopatologia observam-se as principais lesöes da virose, inclusive a presença de corpúsculos de inclusäo em diferentes localizaçöes. A sobrevivência de um único indivíduo, vacinado contra cinomose, reforça a importância desta medida profilática no controle da doença

Comparación de la inmunofluorescencia, ensayo inmunoenzimático y cultivo celular para el diagnóstico de chlamydia trachomatis en infecciones urogenitales / Comparison of immunofluorescence, enzyme immunoassay and cell culture for the diagnosis of Chlamydia trachomatis in urogenital infections

We evaluated the usefulness of the direct immunofluorescence test with monoclonal antibodies and the enzyme immunoassay in comaprison with isolation in cell cultures for the diagnosis of Chlamydia trachomatis in 55 endocervica specimens from female prostitutes and 21 urethral specimens fro men with diagnosis of nongonococcal urethritis. In comparison with culture, the enzyme immunoassay had a sensitivity of 100% and a specificity of 95%. The immunofluorescence test had a sensitivity of 92% and a specificity of 98%. The positive and negative predictive values for the enzyme immunoassay were 81% and 100% and for immunofulorescence 92% and 98% respectively. The immunologic methods appear to be satisfactory alternatives to culture for detecting C trachomatis in genital specimens in the studied populations

Anais do Simpósio Nipo-Brasileiro da Ciência e Tecnologia

Verifica a presença de leveduras potencialmente patógenas ao homem em animais e vegetais e contribui para estudos epidemiológicos de agentes dispersores destes fungos