The effect of post-stroke hyperglycaemia on the levels of brain damage and repair-related circulating biomarkers: the Glycaemia in Acute Stroke Study II.

BACKGROUND AND PURPOSE: The aim was to identify whether post-stroke hyperglycaemia (PSH) influences the levels of circulating biomarkers of brain damage and repair, and to explore whether these biomarkers mediate the effect of PSH on the ischaemic stroke (IS) outcome. METHODS: This was a secondary analysis of the Glycaemia in Acute Stroke II study. Biomarkers of inflammation, prothrombotic activity, endothelial dysfunction, blood-brain barrier rupture, cell death and brain repair processes were analysed at 24-48 h (baseline) and 72-96 h (follow-up) after IS. The associations of the biomarkers and stroke outcome (modified Rankin Scale score at 3 months) based on the presence of PSH were compared. RESULTS: A total of 174 patients participated in this sub-study. Brain-derived neurotrophic factor (BDNF) at admission was negatively correlated with glucose levels. PSH was associated with a trend toward higher levels of endothelial progenitor cells (EPCs) at baseline. The EPCs in the PSH group then decreased in the follow-up samples (-8.5 ± 10.3) compared with the non-PSH group (4.7 ± 7.33; P = 0.024). However, neither BDNF nor EPC values had correlation with the 3-month outcome. Higher interleukin-6 at follow-up was associated with poor outcomes (modified Rankin Scale > 2) independently of PSH. CONCLUSION: Post-stroke hyperglycaemia appears to be associated with a negative regulation of BDNF and a different reaction in EPC levels. However, neither BDNF nor EPCs showed significant mediation of the PSH association with IS outcome, and only higher interleukin-6 in the follow-up samples (72-96 h) was related to poor outcomes, independently of PSH status. Further studies are needed to achieve definite conclusions.

Glycemia in Acute Stroke II study: a call to improve post-stroke hyperglycemia management in clinical practice.

BACKGROUND AND PURPOSE: The aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155 mg/dL (8.5 mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. METHODS: This was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48-h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155 mg/dL (8.5 mmol/L) within the first 48 h; (ii) treated and good responders [glucose levels persistently <155 mg/dL (8.5 mmol/L)]; (iii) treated and non-responders [any glucose values ≥155 mg/dL (8.5 mmol/L) during the 24 h after the start of corrective treatment]; and (iv) untreated with any glucose value ≥155 mg/dL (8.5 mmol/L). The primary outcome was death or dependence at 3 months (blinded rater). RESULTS: A total of 213 patients were included. Ninety-seven (45.5%) patients developed glucose levels ≥155 mg/dL (8.5 mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values ≥155 mg/dL (8.5 mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non-responsive. Non-responders showed a twofold higher risk of death or dependence at 3 months (odds ratio, 2.472; 95% confidence interval, 1.096-5.576; P = 0.029). CONCLUSIONS: Lack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes.

In vitro antiviral activity of Lactobacillus casei and Bifidobacterium adolescentis against rotavirus infection monitored by NSP4 protein production.

AIMS: The aim of this study was to determine the antiviral activity of four probiotic metabolites (Lactobacillus and Bifidobacetrium species) against rotavirus in vitro infection monitored by the NSP4 protein production and Ca(2+) release. METHODS AND RESULTS: The antiviral effect of the metabolites was performed due a comparison between a blocking model and an intracelullar model on MA104 cells, with the response of NSP4 production and Ca(2+) liberation measured by flow cytometry. Significant results were obtained with the metabolites of Lactobacillus casei, and Bifidobacterium adolescentis in the reduction of the protein production (P = 0·04 and P = 0·014) and Ca(2+) liberation (P = 0·094 and P = 0·020) in the intracellular model, which suggests a successful antiviral activity against RV infection. CONCLUSIONS: This study demonstrates that probiotic metabolites were able to interfere with the final amount of intracellular NSP4 protein and a successful Ca(2+) regulation, which suggests a new approach to the mechanism exerted by probiotics against the rotavirus infection. SIGNIFICANCE AND IMPACT OF THE STUDY: A novel anti-rotaviral effect exerted by probiotic metabolites monitored by the NSP4 protein during the RV in vitro infection and the effect on the Ca(2+) release is reported; suggesting a reduction on the impact of the infection by decreasing the damage of the cells preventing the electrolyte loss.

Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus.

Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.

[HIV-1 neuropathogenesis: therapeutic strategies against neuronal loss induced by gp120/Tat glycoprotein in the central nervous system]. / Neuropatogenesis inducida por el virus del sida: estrategias terapeuticas frente a la neurodegeneracion inducida por la glucoproteina gp120/Tat en el sistema nervioso central.

Neuroinflammation is a key process in the neuropathogenesis of AIDS virus since as a result of the aberrant activation of the chemokine receptors (CXCR4, CX3CR1 and CR5) produces proinflammatory cytokine release by infected cells, increases microglial neurotoxicity and generates lipoperoxides and reactive oxygen species (ROS) that eventually damage the neuron. Moreover, the neurotoxin Tat produces dendritic loss by interacting with the low-density lipoprotein receptor (LRP) and also overstimulates N-methyl D-aspartate receptors (NMDA). Furthermore, the aberrant interaction of glycoprotein gp120 with the CXCR4 chemokine receptor causes caspase-3-dependent apoptosis (ceramide is also released) activating apoptotic proteins (p53 and retinoblastoma), which are part of the neurotoxic mechanisms associated to neuronal dysfunction in neuroAIDS. Similarly, gliosis/microglial activation and the release of neurotoxic factors by infected monocytes with elevated amounts of certain chemokines in the cerebrospinal fluid (MCP-1 and fractalkine, among others) contribute to the neuropathogenesis of HIV-1. Alpha-synuclein and beta amyloid deposits have also been detected in post mortem brains of seropositives patients. In addition, there are studies have detected several systemic markers related with the degenerative effects of the virus and its neurotoxins on the central nervous system; such as osteopontin, CD163 and fractalkine, among others. Lastly, clinical trials have been conducted using protective strategies related that attempt to inhibit apoptotic proteins (GSK-3 beta), microglial activation inhibitors (minocycline), antioxidants (selegiline) or trophic factors (IGF-1, growth hormone or erythropoietin). These trials have shown that their treatments are beneficial and complementary to treat complications of HIV/AIDS.

Functional recovery after hematic administration of allogenic mesenchymal stem cells in acute ischemic stroke in rats.

Hematic administration of bone marrow-derived mesenchymal stem cells (MSCs) in acute ischemic stroke may not only be an effective reparative treatment but also a brain protective therapy that improves neurological recovery. Our purpose was to study whether either i.v. or intracarotid (i.c.) administration of allogenic MSCs during the acute phase were effective in improving neurological recovery and decreasing brain damage in an experimental rat model. In a model of permanent middle cerebral artery occlusion (pMCAO), we analyzed: neurological evaluation; MSCs migration and implantation; interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels; lesion volume; cell death; cellular proliferation; vascular endothelial growth factor (VEGF) expression and blood vessel number. Regardless of the administration route, treated groups showed better neurological recovery, without significant differences between the two groups. Migration and implantation of MSCs in the lesion area was observed in animals receiving i.c. but not i.v. treatment. The highest cytokine values were observed in the i.v. MSCs and i.c. control groups, and these levels were significantly different from the corresponding i.v. control and i.c. MSCs groups, respectively. In addition, there were significant differences between the i.v. MSCs and i.c. MSCs groups in IL-6 levels. Neither treatment reduced infarction volume. However, cell death, measured as TUNEL+ cells was decreased with significant differences between control groups. BrdU+ cells were also significantly increased in the peri-infarct zone at 14 days. VEGF expression was significantly higher in the i.c. MSCs group than in the i.c. control group and blood vessel number was significantly higher in treated groups than control groups with significant differences in the peri-infarct zone at 14 days. We conclude that allogenic MSCs administration shows therapeutic efficacy in our acute ischemic stroke model. Both routes demonstrably improved neurological recovery and provided brain protection.

[Massive pleural empyema caused by pyonephrosis]. / Empiema pleural masivo secundario a pionefrosis.

The pleural empyema has unusual origin at extralung causes. Then, is essential to identify the primary process in order to obtain the clinical setting control. Previously described, but even exceptional, this case report show an empyema in which it's origin was an asymtomatic pyonephrosis, caused because of a big kidney calculus and it's discovery was suspected by the bacillus results. The treatment must include appropriate antibiotic therapy and thoracic drainage, and also the drain of the purulent accumulations at the kidney and perikidney area.

[Air seepage from endotracheal tube cuffs during anesthetic procedures. How to solve this problem without changing tubes? An experimental model using human tracheas]. / Pérdida de aire en los manguitos de los tubos endotraqueales durante el procedimiento anestésico. Cómo solucionar este problema sin cambiar el tubo? Modelo experimental con tráqueas humanas.

OBJECTIVES: To demonstrate by an experimental model that a continuous medicinal airflow system giving a pressure of 30 cmH2O effectively stops leakage from endotracheal tubes. MATERIAL AND METHODS: Ten tracheas with their main bronchi were removed from cadavers with no pulmonary disease. The tracheas were placed vertically and tubes previously perforated with increasing caliber needles were inserted and connected to a continuous flow system. The flow of medicinal air generated in the cuff was monitored with a flow meter and pressure was measured with a manometer. When a pressure of 30 cmH2O was reached, the trachea was filled with saline. We then observed the moment at which, when pressure fell, the saline began to leak from the bronchi. The levels observed were expressed as arithmetic means and standard deviations. RESULTS: No leakage was observed when the flow produced pressures above 10 cmH2O for 25 G caliber holes, above 15 cmH2O for 24 G holes, or above 20 cmH2O for 25 G, 21 G, 20 G, 18 G or 16 G holes. For 14 G holes, a flow producing pressures over 25 cmH2O were needed. Pressure up to 80 cmH2O was required to stop leakage from a scalpel cut. CONCLUSIONS: We found that adjusting flow and pressure is a valid way to stop leakage from small holes. The method does not control leakage from large holes or cuts.

[An epidemiological analysis of the sequence of bladder control and nocturnal enuresis prevalence in the children of the province of León]. / Análisis epidemiológico de la secuencia de control vesical y prevalencia de enuresis nocturna en niños de la provincia de León.

The objective of this study was to better understand the development of nocturnal bladder control in our population of children and to analyze the different factors that influence this process. A transversal epidemiological study in a randomly chosen sample of schoolchildren, between the ages of 6 and 10 years, in the province of Leon was performed. The study was carried out by means of an anonymous survey given to the children's parents through the school center. The survey was comprised of personal, environmental and sphincter control development questions. We define nocturnal enuresis as at least one wet night per month in children older than 6 years of age. Of the surveys distributed, 65.1% were answered. The prevalence of primary, secondary and total nocturnal enuresis was 10.18%, 2.91% and 13.09%, respectively, for children 6 years of age and 6.59%, 0.9% and 7.49%, respectively in 10 year old children. Among the children without nocturnal enuresis, in the event of family antecedents of nocturnal enuresis, in absence of toilet training, or when sphincter education was started later than 15 months of age, slower maturation of sphincter control was observed. We conclude, that the nocturnal enuresis prevalence is similar to that reported in other related countries and that bladder control maturation among children without bed-wetting tendencies is related to the educational attitude of the parents and family antecedents of nocturnal enuresis.

[Primary and secondary nocturnal enuresis. Are they different entities?]. / Enuresis nocturna primaria y secundaria. Son entidades diferentes?

The aim of this study was to know the prevalence and predominant factors of primary and secondary enuresis in schoolchildren. For this purpose, a randomized epidemiological study was performed on a representative sample of the general population of children, aged 6 and 10 years, living in the province of Leon. Their parents responded to a questionnaire that evaluated, in both forms of enuresis, what are the predominant factors, including: familiar, socioeconomic, personal, education and psychological factors. We found that in a selected population of 1,307 children, 171 presented nocturnal enuresis when they were 6 years old (13.09% +/- 0.93%). Of these, 133 had primary (10.18 +/- 0.84%) and 38 (2.91 +/- 0.46%) secondary enuresis. We found no significant differences between the two forms in regards to familiar, socioeconomic, personal education or psychological factors. The only differences were that in secondary enuresis, the parents were older (p < 0.05) and less education (p < 0.01) on the subject of bladder control, and a later onset of the same (p < 0.05), was given. We conclude that the prevalence of primary enuresis is 10.18% +/- 0.84% and that of secondary enuresis is 2.91% +/- 0.46%. We do not find clear differences that permit us to consider these two types of enuresis as different forms.

[An epidemiological study of pediatric emergencies in a general hospital. The factors involved in inappropriate demand]. / Estudio epidemiológico de las urgencias pediátricas en un hospital general. Factores implicados en una demanda inadecuada.

UNLABELLED: We have carried out a retrospective study of a representative sample of the infant population attended at our pediatric hospital emergency service (PES) during 1992 in order to determine the frequency of unnecessary consultations and the implicated factors. PATIENTS AND METHODS: During this time period, 6,543 pediatric emergencies (except traumatisms) were attended, of which 1,298 cases were selected. We analyzed the epidemiological patient profile, motive for consultation, final diagnosis, type of emergency and factors involved in unnecessary consultations. RESULTS: We found that the most commonly attended groups of diagnosis were respiratory diseases (37%), ill-defined signs and symptoms (22%) and infectious diseases (13%). Sixty-nine percent of the patients were catalogued as unnecessary emergency consultations and a statistical relationship was found with factors such as: age less than 7 years (76%), arrival by initiative of the patients themselves (76%), onset of symptoms between 1-4 days (77%) and the time of day between 2.200 and 07.00 hours (75%). CONCLUSIONS: We conclude unnecessary consultations occur at a high frequency. We comment on the importance of the age of the patient, who takes the initiative to come to the PES, the duration of the symptoms and the hour of consultation as predictive variables to suggest poor use of these pediatric services.