Sciatic and median nerve neurolymphomatosis as initial presentation of B-cell lymphoma.

Neurolymphomatosis (NL) is the infiltration of cranial nerves or nerves and roots from the peripheral nervous system by lymphoma, usually by B-cell non-Hodgkin's lymphoma. It is uncommon as initial presentation of the disease and can lead to extremely heterogeneous clinical manifestations. We report the case of a 72-year old male who presented with numbness of the right hand, progressive weakness in both lower limbs and weight loss. 18F-FDG PET/CT showed bilateral hypermetabolic adrenal masses, gastric ulcer, small hypermetabolic adenopathies, multiple focal bone marrow uptake and intense uptake in both sciatic nerves and right median nerve. A node and gastric biopsy confirmed diffuse large-B-cell lymphoma, activated B cell type, with posterior resolution of peripheral nerves uptake after beginning chemotherapy.

Draft Genome Sequences of Two Cyanobacteria Leptolyngbya spp. Isolated from Microbial Mats in Miravalles Thermal Spring, Costa Rica.

We report the draft genome sequences of Leptolyngbya sp. strain 7M and Leptolyngbya sp. strain 15MV, isolated from Miravalles Thermal Spring, Costa Rica. The thermophilic cyanobacteria exhibit unique diversity features that provide insight into the adaptation and evolution of phototrophic microorganisms in geothermal habitats.

Sciatic and median nerve neurolymphomatosis as initial presentation of B-cell Lymphoma. / Neurolinfomatosis de los nervios ciáticos y mediano como presentación inicial del linfoma de linfocitos B.

Neurolymphomatosis (NL) is the infiltration of cranial nerves or nerves and roots from the peripheral nervous system by lymphoma, usually by B-cell non-Hodgkin's lymphoma. It is uncommon as initial presentation of the disease and can lead to extremely heterogeneous clinical manifestations. We report the case of a 72-year old male who presented with numbness of the right hand, progressive weakness in both lower limbs and weight loss. 18F-FDG PET/CT showed bilateral hypermetabolic adrenal masses, gastric ulcer, small hypermetabolic adenopathies, multiple focal bone marrow uptake and intense uptake in both sciatic nerves and right median nerve. A node and gastric biopsy confirmed diffuse large-B-cell lymphoma, activated B cell type, with posterior resolution of peripheral nerves uptake after beginning chemotherapy.

Dust Impacts on the 2012 Hurricane Nadine Track during the NASA HS3 Field Campaign.

During the 2012 deployment of the NASA Hurricane and Severe Storm Sentinel (HS3) field campaign, several flights were dedicated to investigating Hurricane Nadine. Hurricane Nadine developed in close proximity to the dust-laden Saharan Air Layer, and is the fourth longest-lived Atlantic hurricane on record, experiencing two strengthening and weakening periods during its 22-day total lifecycle as a tropical cyclone. In this study, the NASA GEOS-5 atmospheric general circulation model and data assimilation system was used to simulate the impacts of dust during the first intensification and weakening phases of Hurricane Nadine using a series of GEOS-5 forecasts initialized during Nadine's intensification phase (12 September 2012). The forecasts explore a hierarchy of aerosol interactions within the model: no aerosol interaction, aerosol-radiation interactions, and aerosol-radiation and aerosol-cloud interactions simultaneously, as well as variations in assumed dust optical properties. When only aerosolradiation interactions are included, Nadine's track exhibits sensitivity to dust shortwave absorption, as a more absorbing dust introduces a shortwave temperature perturbation that impacts Nadine's structure and steering flow, leading to a northward track divergence after 5 days of simulation time. When aerosol-cloud interactions are added, the track exhibits little sensitivity to dust optical properties. This result is attributed to enhanced longwave atmospheric cooling from clouds that counters shortwave atmospheric warming by dust surrounding Nadine, suggesting that aerosol-cloud interactions are a more significant influence on Nadine's track than aerosol-radiation interactions. These findings demonstrate that tropical systems, specifically their track, can be impacted by dust interaction with the atmosphere.

Relationship between acute kidney injury and serum procalcitonin (PCT) concentration in critically ill patients with influenza infection.

INTRODUCTION: Serum procalcitonin (PCT) concentration could be increased in patients with renal dysfunction in the absence of bacterial infection. OBJECTIVE: To determine the interactions among serum renal biomarkers of acute kidney injury (AKI) and serum PCT concentration, in patients admitted to the intensive care unit (ICU) due to lung influenza infection. DESIGN: Secondary analysis of a prospective multicentre observational study. SETTING: 148 Spanish ICUs. PATIENTS: ICU patients admitted with influenza infection without bacterial co-infection. Clinical, laboratory and hemodynamic variables were recorded. AKI was classified as AKI I or II based on creatinine (Cr) concentrations (≥1.60-2.50mg/dL and Cr≥2.51-3.99mg/dL, respectively). Patients with chronic renal disease, receiving renal replacement treatment or with Cr>4mg/dL were excluded. Spearman's correlation, simple and multiple linear regression analysis were performed. INTERVENTIONS: None. RESULTS: Out of 663 patients included in the study, 52 (8.2%) and 10 (1.6%) developed AKI I and II, respectively. Patients with AKI were significantly older, had more comorbid conditions and were more severally ill. PCT concentrations were higher in patients with AKI (2.62 [0.60-10.0]ng/mL vs. 0.40 [0.13-1.20]ng/mL, p=0.002). Weak correlations between Cr/PCT (rho=0.18) and Urea (U)/PCT (rho=0.19) were identified. Simple linear regression showed poor interaction between Cr/U and PCT concentrations (Cr R2=0.03 and U R2=0.018). Similar results were observed during multiple linear regression analysis (Cr R2=0.046 and U R2=0.013). CONCLUSIONS: Although PCT concentrations were slightly higher in patients with AKI, high PCT concentrations are not explained by AKI and could be warning sign of a potential bacterial infection.

Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection.

INTRODUCTION: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. METHODS: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. RESULTS: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. CONCLUSIONS: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.

[Pandemic influenza A in the ICU: experience in Spain and Latin America. GETGAG/SEMICYUC/(Spanish Working Group on Severe Pandemic Influenza A/SEMICYUC)]. / Gripe A pandémica en una unidad de cuidados intensivos: experiencia en España y Latinoamérica (Grupo Español de Trabajo de Gripe A Grave/Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias).

INTRODUCTION: Pandemic Influenza A (H1N1)v infection is the first pandemic in which intensive care units (ICU) play a fundamental role. It has spread very rapidly since the first cases were diagnosed in Mexico with the subsequent spread of the virus throughout the Southern Cone and Europe during the summer season. OBJECTIVE: This study has aimed to compare the clinical presentation and outcome among the critical patients admitted to the ICU until July 31, 2009 in Spain with some series from Latin America. MATERIAL AND METHOD: Six series of critically ill patients admitted to the ICU were considered. Clinical characteristics, complications and outcome were compared between series. RESULTS: Young patients (35-45 years) with viral pneumonia as a predominant ICU admission cause with severe respiratory failure and a high need of mechanical ventilation (60-100%) were affected. Obesity, pregnancy and chronic lung disease were risk factors associated with a worse outcome, however there was a high number of patients without comorbidities (40-50%). Mortality rate was between 25-50% and higher in the Latin America series, demonstrating the specific potential pathogenesis of the new virus. The use of antiviral treatment was delayed (between 3 and 6 days) and not generalized, with greater delay in Latin America in regards to Spain. CONCLUSIONS: These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality.

Score de disfunción multiorgánica(MODS): su aplicación en 200 pacientes críticos / Multiorganic dysfunction score (MODS): its application in 200 critical patients

Objetivo: Valorar la efectividad del score de disfunción múltiple de órganos (MODS) en pacientes internados en una unidad de cuidados intensivos polivalente, y comparar estos resultados con los obtenidos por Marshall. Diseño: Estudio prospectivo observacional. Marco: Unidad de cuidados intensivos generales de un Hospital Universitario Asociado, en Buenos Aires, Argentina. Pacientes: 280 pacientes, admitidos por más de 24 horas, desde julio de 1996 hasta julio de 1997. Intervenciones: Ninguna. Método y resultados principales: Aplicamos el MODS sobre 280 pacientes, utilizando los peores valores de las primeras horas de internación. También analizamos la edad, sexo, condición clínica o quirúrgica, APACHE II y evolución. La mortalidad global fue 37,85 por ciento, significativamente diferente a la reportada por Marshall, que fue de 9,4 por ciento (p < 0,001). No hubo diferencias en el APACHE II entre nuestros resultados y los obtenidos por Marshall (12,87 ñ 6,9 vs 13,6 ñ 5,5 - pNS). Existieron diferencias significativas con respecto a edad, APACHE II y MODS entre sobrevivientes y no sobrevivientes. Sin embargo, al comparar pacientes clínicos vs. quirúrgicos, no hubo diferencias en mortalidad, edad o APACHE II, pero el valor de MODS fue significativamente mayor en pacientes clínicos (2,18 ñ 1,9 vs. 1,3 ñ 1,7 - p < 0,001). El Test de Goodness of Fit, fue de 67,7 (p < 0,001), y el rango de clasificación correcta fue de 75,5 por ciento. El área bajo la curva ROC fue de 0,77. La calibración de la mortalidad de diferentes niveles de MODS, entre nuestros resultados y los de Marshall no fue buena. Conclusión: En pacientes internados en una UTI polivalente, el MODS realizado dentro de las primeras 24 horas de la admisión, no parece resultar un buen score