Autonomic nervous system involvement in autoimmune encephalitis and paraneoplastic neurological syndromes.

In autoimmune neurological diseases, the autonomic nervous system can be the primary target of autoimmunity (e.g. autoimmune autonomic ganglionopathy), or, more frequently, be damaged together with other areas of the nervous system (e.g. Guillain-Barré syndrome). Patients with autoimmune encephalitis and paraneoplastic neurological syndromes (PNS) often develop dysautonomia; however, the frequency and spectrum of autonomic signs and symptoms remain ill defined except for those scenarios in which dysautonomia is a core feature of the disease. Such is the case of Lambert-Eaton myasthenic syndrome, Morvan syndrome or anti-NMDAR encephalitis; in the latter, patients with dysautonomia have been reported to carry a more severe disease and to retain higher disability than those without autonomic dysfunction. Likewise, the presence of autonomic involvement indicates a higher risk of death due to neurological cause in patients with anti-Hu PNS. However, in anti-Hu and other PNS, as well as in the context of immune checkpoint inhibitors' toxicities, the characterization of autonomic involvement is frequently overshadowed by the severity of other neurological symptoms and signs. When evaluated with tests specific for autonomic function, patients with autoimmune encephalitis or PNS usually show a more widespread autonomic involvement than clinically suggested, which may reflect a potential gap of care when it comes to diagnosing dysautonomia. This review aims to revise the autonomic involvement in patients with autoimmune encephalitis and PNS, using for that purpose an antibody-based approach. We also discuss and provide general recommendations for the evaluation and management of dysautonomia in these patients.

Two new Neotetraonchus species (Dactylogyridea, Dactylogyridae) parasitising the Peruvian sea catfish Galeichthys peruvianus (Siluriformes, Ariidae), including molecular data.

As part of a parasitological survey, several specimens of two new monopisthocotylean species, Neotetraonchus celsomanueli sp. nov. and N.peruvianus sp. nov. (Dactylogyridea, Dactylogyridae), were collected from the gill filaments of the Peruvian sea catfish Galeichthys peruvianus (Siluriformes, Ariidae) off Puerto Pizarro, Tumbes region, Peru. Neotetraonchus celsomanueli sp. nov. is characterised by an MCO with a T-shaped distal end and an accessory piece that is ribbed and expanded proximally with a worm-shaped termination. Neotetraonchus peruvianus sp. nov. is typified by its MCO, which has a sledgehammer-shaped distal end and an accessory piece with a claw-shaped distal end. Additionally, N.peruvianus sp. nov. is characterised by its jellyfish-shaped onchium. A partial 28S rDNA sequence was obtained from N.celsomanueli sp. nov., and a phylogenetic analysis was conducted. This analysis revealed the phylogenetic position of Neotetraonchus celsomanueli sp. nov. within a clade comprising monopisthocotylean parasites of diadromous and marine ariid catfishes, including Hamatopeduncularia spp., Chauhanellus spp., Thysanotohaptor Kritsky, Shameem, Kumari & Krishnaveni, , and Neocalceostomoides spinivaginalis Lim, 1995. This finding brings the number of known Neotetraonchus species to seven and represents the first described Neotetraonchus species infecting marine catfishes from Peru.

Integrative Taxonomy of Prosogonotrema bilabiatum Vigueras, 1940 (Digenea: Sclerodistomidae): A Parasite in Atlantic Spadefish Chaetodipterus faber (Broussonet, 1782) (Acanthuriformes: Ephippidae) from Brazil.

OBJECTIVES: The present work aims to expand the knowledge of the digenean species Prosogonotrema bilabiatum (Sclerodistomidae), a parasite of Chaetodipterus faber (Acanthuriformes) from Brazil, with an integrative taxonomic approach, using light microscopy, scanning electron microscopy, histology, and molecular biology. METHODS: Forty-one digenean specimens were stained with hydrochloric carmine for morphological studies. Eleven parasites were dehydrated through a graded ethanol series, critical point dried with carbon dioxide, and coated with gold for scanning electron microscopy analysis. Four specimens were processed following histological routine and stained with hematoxylin and eosin and Gomori trichrome. DNA extracted was amplified using 28S partial primer D1-D3. Maximum likelihood and Bayesian inference were performed for phylogenetic analysis. RESULTS: Morphometric and morphological data of the specimens studied ranged in accordance as observed in previous descriptions of the species. Observations from scanning electron microscopy and histology corroborated with those observed in stained whole mounts. Molecular analysis showed that specimens of P. bilabiatum from Brazil clustered with another two sequences of this species from different hosts and localities, with a high node support value. CONCLUSIONS: The integrative taxonomic approach allowed to record and describe new characteristics of P. bilabiatum related to the tegument, the structure and the arrangement of its tissues. The use of molecular markers confirmed that specimens identified as P. bilabiatum from different hosts and localities are all conspecific. Further studies, mainly molecular with less conserved genetic markers, should be carried out to better understand the phylogenetic relationships of Prosogonotrema with Hemiuroidea.

Morphological and Molecular Analyses of Aponurus laguncula Looss, 1907 (Digenea: Lecithasteridae) Parasitic in Atlantic Spadefish Chaetodipterus faber (Broussonet, 1782) (Acanthuriformes: Ephippidae) from Brazilian Coastal Zone.

OBJECTIVES: An integrative taxonomic description of Aponurus laguncula (Lecithasteridae), a digenean parasitic species of Chaetodipterus faber (Acanthuriformes) from Brazilian Southeast, is provided. Morphological techniques, as whole mounted slides, histology and scanning electron microscopy, and molecular analyses supported that integrative description. METHODS: Fifteen digenean specimens were stained in hydrochloric carmine and mounted on permanent slides. Two specimens were stained in hematoxylin and eosin following histological routine processing. Four parasites were dehydrated through a graded ethanol series, critical point dried with carbon dioxide and coated with gold to scanning electron microscopy analysis. Sequence of the large ribosomal subunit (28S rDNA) gene was generated and used to construct a phylogeny based on maximum likelihood and Bayesian inference analyses. RESULTS: Morphological description and morphometric data obtained in present study were in accordance with previous studies of the species. Use of another morphological techniques, as scanning electron microscopy and histology, corroborated the observed features of whole mounted slides. Also, they provided a better observation of previous reported characteristics and new features reporting, such as an elongated hermaphroditic duct, a smooth tegument and cells that compose the prostatic gland. The molecular sequence obtained in the present study formed a robust clade with available sequences of species of Aponurus. CONCLUSIONS: The integrative taxonomic approach successfully combined morphological observations, including both previously reported features and new descriptions from histological and electron microscopy analyses, with molecular data to identify these specimens as A. laguncula. Moreover, the detailed characterization of structures, such as the gonads in A. laguncula, that would be challenging to analyze using a single technique, was possible. Further molecular studies with less conserved genetic markers should be conducted to understand phylogenetic relationships between Aponurus species.

Análisis integral de la colecistectomía en una unidad de cirugía ambulatoria y corta estancia. Experiencia de los últimos 7 años / Integral analysis of cholecystectomy in an outpatient surgery and short-stay unit. Experience of the last 7 years

Introducción: La colecistectomía laparoscópica ambulatoria (CLA) se considera en la actualidad un trazador representativo de la calidad de un servicio de cirugía general. La gran diversidad de unidades de cirugía ambulatoria dificulta la comparativa de los diferentes indicadores de calidad. Objetivo: Conocer los resultados del manejo de la CLA en un centro integrado y como afecta a sus indicadores de calidad. Pacientes y método: Estudio observacional prospectivo entre 2015 y 2021 de las colecistectomías programadas en unidad integrada. Resultados: Se intervinieron 887 pacientes, el 76,5 % (n = 679) programados en régimen ambulatorio. La pernocta no planificada (PNP) media fue del 25,2 % (n = 171), siendo el índice de sustitución del 57,8 %. Las principales causas de PNP fueron: intolerancia digestiva (48,5 %), cirugía compleja (29,2 %) y el dolor (12,8 %). Los tiempos quirúrgicos fueron superiores en los pacientes en régimen de ingreso (p < 0,001) y en aquellos que causaron PNP (p < 0,001). Un tiempo quirúrgico superior a los 45 minutos fue causa de PNP de forma significativa (p = 0,007). La tasa global de infección de sitio quirúrgico fue del 3,1 %,siendo la infección profunda del 0,59 %. Ningún paciente reingresó en las primeras 24 horas, siendo la asistencia a urgencias a 30 días del 8,2 % (n = 73),reingresando el 1,91 % (n = 17) de los pacientes, con una tasa de reintervención del 0,35 % (n = 3). La tasa de fístula biliar fue del 0,67 %. Conclusión: La CLA es una técnica segura y expansiva, aunque la obtención de parámetros de calidad estandarizados es complejo por la diversidad de unidades.(AU)

Introduction: Ambulatory laparoscopic cholecystectomy (ALC) is currently considered a representative tracer of the quality of a general surgery service. The great diversity of day surgery units makes it difficult to compare the different quality index. Objective: To know the results of the management of the CLA in an integrated center and how it affects its quality index. Patients and method: Prospective observational study between 2015 and 2021 of scheduled cholecystectomies in an integrated unit. Results: 887 patients were operated on, 76.5 % (n = 679) programmed on an outpatient basis. The average unplanned overnight stay (PNP) was 25.2 % (n = 171), with the replacement rate being 57.8 %. The main causes of PNP were: digestive intolerance (48.5 %), complex surgery (29.2 %) and pain (12.8 %). Surgical times were higher in patients on admission (p < 0.001) and in those who caused PNP (p < 0.001). Surgical time greater than 45 minutes was a significant cause of PNP (p = 0.007). The overall rate of surgical site infection was 3.1 %, with deep infection being 0.59 %. No patient was readmitted in the first 24 hours, with 30-day emergency care being 8.2 % (n = 73), readmission rate of 1.91 % (n = 17), with a reoperation rate of 0.35 % (n = 3). The biliary fistula rate was 0.67 %. Conclusion: CLA is a safe and expansive technique, although obtaining quality standard parameters is complex due to the diversity of units.(AU)

Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso / Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report

Introduction: New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology. Case report: We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding. Conclusion: It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.(AU)

Introducción: El estado epiléptico superrefractario de nueva aparición (NOSRSE) es una emergencia neurológica caracterizada por el desarrollo de estado epiléptico en un paciente sin epilepsia ni enfermedad neurológica previa conocida y sin clara causa estructural, tóxica o metabólica, que recurre tras 24 horas del coma inducido. La causa identificable más frecuente es la inflamatoria-autoinmune. En consecuencia, planteamos un caso de NOSRSE relacionado con la vacunación para el SARS-CoV-2 como una oportunidad de indagar el origen disinmune de esta patología. Caso clínico: Varón de 40 años que acude al servicio de urgencias refiriendo fiebre y cefalea sin claro foco infeccioso. Entre sus antecedentes personales destacamos una meningitis bacteriana en la infancia sin secuelas y un déficit de proteína S sin tratamiento en ese momento, así como vacunación con ChAdOx1 nCoV-19 21 días antes. Fue inicialmente diagnosticado de infección del tracto urinario y tratado con cefuroxima. Dos días después, se le llevó de nuevo a urgencias con cuadro confusional y crisis tonicoclónicas, sin respuesta al midazolam, y requirió finalmente sedación e intubación orotraqueal por estado epiléptico refractario. Durante su ingreso requirió múltiples líneas de antiepilépticos, quetamina, dieta cetógena, inmunoterapia y plasmaféresis para conseguir limitar el NOSRSE. El estudio etiológico ofrecía normalidad de los resultados de serología, anticuerpos antineuronales en el suero y líquido cefalorraquídeo, ecocardiografía transtorácica, ecografía testicular y angiotomografía computarizada. Únicamente la resonancia magnética de control mostró una alteración difusa y bilateral de la corteza hemisférica y pulvinar talámica derecha como único hallazgo. Conclusión: Es crucial notificar las sospechas de reacciones adversas asociadas a la vacunación frente al SARS-CoV-2, permitiendo así una supervisión continuada de la relación riesgo/beneficio de ésta.(AU)

Evolutionary dynamics of autopolyploids in natural populations: the case of Turnera sidoides complex / Dinámica evolutiva de autopoliploides en poblaciones naturales: el caso del complejo Turnera sidoides

ABSTRACT Turnera sidoides (x=7) is one of the few well-studied South American autopolyploid complexes. Since polyploidy has played a prominent role within this complex, ongoing studies in T. sidoides focus on understanding the mechanisms involved in the origin and the establishment of polyploids using integrative approaches. This paper synthesises the results of more than 20 years of research on this topic. Cytogenetics analysis provided evidences for the production of unreduced male and female gametes, supporting the hypothesis of bilateral sexual polyploidization as the mechanism of origin of polyploids in T. sidoides. The finding of viable triploids suggested that unilateral sexual polyploidization could also be an important mechanism for the origin of tetraploids in T. sidoides. The occurrence of plants continuously forming many unreduced gametes would play a key role in the establishment of neopolyploids in natural populations. Also, the higher number of propagules that tetraploids contribute to subsequent generations, the ability to multiply asexually by rhizomes, and the occurrence of occasional cases of self-compatibility and successful illegitimate crosses in polyploids increase the likelihood that a low frequency of neopolyploids can be maintained in natural populations of T. sidoides. In addition, integration of cytogeographic and genetic divergence data together with past niche modelling provided further insights supporting the hypothesis that historical climatic and geomorphological events provided favourable conditions for the establishment of autopolyploids, with the wider distribution of tetraploids of T. sidoides being the result of their range expansion.

RESUMEN Turnera sidoides (x=7) es uno de los pocos complejos autopoliploides sudamericanos bien estudiados. Como la poliploidía ha tenido un papel destacado en el complejo, los estudios en curso en T. sidoides se centraron en la comprensión de los mecanismos implicados en el origen y el establecimiento de los poliploides mediante diferentes enfoques. En este trabajo se sintetizan los resultados de más de 20 años de investigación sobre este tema. El análisis citogenético proporcionó evidencias de la producción de gametos masculinos y femeninos no reducidos, sustentando la hipótesis de la poliploidización sexual bilateral como mecanismo de origen de los poliploides en T. sidoides. Sin embargo, el hallazgo de triploides fértiles sugirió que la poliploidización sexual unilateral también sería un mecanismo importante de origen de tetraploides en T. sidoides. La ocurrencia de plantas que forman continuamente gametos no reducidos desempeñaría un papel clave en el establecimiento de neopoliploides. Además, el mayor número de propágulos que los tetraploides aportan a las siguientes generaciones, la capacidad de multiplicación asexual por rizomas y los casos ocasionales de autocompatibilidad y cruzamientos ilegítimos exitosos aumentarían la probabilidad de que se mantenga una baja frecuencia de neopoliploides en las poblaciones naturales de T. sidoides. Asimismo, la integración de datos citogeográficos y de divergencia genética junto con el modelado de nicho en el pasado aportó información que sustenta la hipótesis de que los eventos climáticos y geomorfológicos históricos proporcionaron las condiciones favorables para el establecimiento y expansión de los tetraploides de T. sidoides.

Incidencia y manejo fisioterápico del síndrome de resección anterior bajo / Incidence and physiotherapeutic management of low anterior resection syndrome

Antecedentes y objetivos El cáncer colorrectal es el tercer cáncer más frecuente a nivel mundial. Las nuevas técnicas quirúrgicas, la radioterapia y quimioterapia han aumentado significativamente la supervivencia, pero alterando la funcionalidad del colon. El síndrome de resección anterior baja (LARS) puede conllevar incontinencia a gases y líquidos, urgencia defecatoria, lo que condiciona la calidad de vida. El LARS puede mejorar con la aplicación de técnicas fisioterápicas. El objetivo del trabajo es conocer la incidencia, distribución y gravedad del LARS en nuestra área de salud para identificar a sujetos susceptibles de tratamiento fisioterápico. Pacientes Estudio observacional descriptivo de pacientes operados por cáncer de recto entre enero de 2017 y septiembre de 2021, tras aceptación del estudio por el Comité de Ética de la Investigación. Se realizó una valoración clínica y de la calidad de vida con el cuestionario LARS score. Resultados De los 79 pacientes detectados, fueron incluidos en el estudio 21 divididos en 2grupos. No hubo diferencias significativas en las variables estudiadas, si bien la incidencia de LARS alcanzó el 68,4%, que fue de la forma mayor en el 61,5% y afectó más frecuentemente a mujeres de edad inferior a los que presentaban una forma más leve. Los pacientes refirieron gran repercusión sobre la conducta y sensación de vergüenza. No existen protocolos de prevención o manejo activo para ellos. Conclusiones La incidencia de LARS bajo afecta a 2 terceras partes de nuestra población, con predominio de la forma mayor (AU)

Background and objective Colorectal cancer is the third most common cancer worldwide. New surgical techniques, radiotherapy and chemotherapy have significantly increased survival but altering the functionality of the colon. Low anterior resection syndrome (LARS), it can lead to gas and liquid incontinence, defecation urgency conditioning the quality of life. This can improve with the application of physiotherapy techniques. The objective of the work is to know the incidence, distribution and severity of the LARS in our health area, which allows us to identify subjects susceptible to physiotherapy treatment. Patients Descriptive observational study of patients operated on for rectal cancer between January 2017 and September 2021, after acceptance of the study by Research Ethics Committee. A clinical and quality of life assessment was performed using the LARS score questionnaire. Results Of the 79 patients detected, 21 were included in the study, divided into 2groups. There were no significant differences in the variables studied, although the incidence of LARS reached 68.4%, being higher in 61.5%, more frequently affecting younger women than those who presented a milder form. The patients reported a great repercussion on their behavoir and the feeling of shame that their lifestyle had, and there were no prevention and/or active management protocols for them. Conclusions The incidence of low anterior resection syndrome affects 2thirds of our population, with a predominance of the major form (AU)

Validación en pediatría de un método para notificación y seguimiento de errores de medicación / Validation of a method for notifying and monitoring medication errors in pediatrics

OBJETIVO: Analizar el impacto en la notificación de errores de medicación de la puesta en marcha de un comité de seguridad multidisciplinar descentralizado en la unidad de gestión pediátrica, e implantación conjunta de una aplicación informática en red para la comunicación de errores de medicación, mediante seguimiento de los errores y análisis de las mejoras. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, transversal pre-post intervención. Se analizan los errores de medicación notificados a la comisión central de seguridad, en los 12 meses previos a la implantación, y los notificados mediante la aplicación informática descentralizada a la comisión de seguridad de la unidad de gestión, en los 9 meses posteriores, y las estrategias generadas por el análisis. Variables medidas: Número de errores notificados por 10.000 días de estancia, número de errores con daño por 10.000 días de estancia, tipo, categoría en función de la gravedad, fase del proceso, colectivo que notifica y medicamentos implicados. RESULTADOS: Se multiplican por 4,6 los errores de medicación notificados -7,6 notificaciones por 10.000 días de estancia en el periodo preintervención y 36 en el postintervención-, razón de tasas de 0,21 (IC 95%: 0,11-0,39) p < 0,001. No cambian prácticamente los errores con daño o que necesitaron monitorización notificados por 10.000 días de estancia de un periodo a otro, razón de tasas: 0,77 (IC95%: 0,31-1,91) p > 0,05. Se multiplica por 17,4 la notificación de errores sin daño o potenciales por 10.000 días de estancia, razón de tasas: 0,005 (IC 95%: 0,001-0,026) p < 0,001. CONCLUSIONES: El incremento de los errores de medicación notificados en el periodo postintervención es reflejo del aumento en la motivación de los profesionales sanitarios para notificar a través de este nuevo método

OBJECTIVE: To analyze the impact of a multidisciplinary and decentralized safety committee in the pediatric management unit, and the joint implementation of a computing network application for reporting medication errors, monitoring the follow-up of the errors, and an analysis of the improvements introduced. MATERIAL AND METHODS: An observational, descriptive, cross-sectional, pre-post intervention study was performed. An analysis was made of medication errors reported to the central safety committee in the twelve months prior to introduction, and those reported to the decentralized safety committee in the management unit in the nine months after implementation, using the computer application, and the strategies generated by the analysis of reported errors. Measured variables: Number of reported errors/10,000 days of stay, number of reported errors with harm per 10,000 days of stay, types of error, categories based on severity, stage of the process, and groups involved in the notification of medication errors. RESULTS: Reported medication errors increased 4.6 -fold, from7.6 notifications of medication errors per 10,000 days of stay in the pre-intervention period to 36 in the post-intervention, rate ratio 0.21 (95% CI; 0.11-0.39) (P < .001). The medication errors with harm or requiring monitoring reported per 10,000 days of stay, was virtually unchanged from one period to the other ratio rate 0,77 (95% IC; 0,31-1,91) (P>.05). The notification of potential errors or errors without harm per 10,000 days of stay increased 17.4-fold (rate ratio 0.005., 95% CI; 0.001-0.026, P < .001). CONCLUSIONS: The increase in medication errors notified in the post-intervention period is a reflection of an increase in the motivation of health professionals to report errors through this new method

Parasite fauna of wild and cultured dusky-grouper Epinephelus marginatus (Lowe, 1834) from Ubatuba, southeastern Brazil / Fauna parasitária da garoupa selvagem e de cultivo Epinephelus marginatus (Lowe, 1834) em Ubatuba, sudeste do Brasil

This study aimed at identifying and quantifying the parasites of wild and cultured dusky grouper Epinephelus marginatus. During a year and thereby all four seasons, 20 wild and 20 cultured groupers were examined for the presence of parasites, except in the last season, in which 19 wild and 20 cultured fish were examined, totalling 159 groupers analysed from Ubatuba, southeastern Brazil. Prevalence, mean intensity of infection, mean abundance and mean relative dominance were calculated. Five species of parasites were identified in fish from both origins: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) and larvae of Contracaecum sp. (Nematoda). The prevalence of ectoparasites, in most cases, was higher than endoparasites. The most abundant parasite was the monogenea Pseudorhabdosynochus beverleyburtonae in both wild and cultured fish, along all seasons. Neobenedenia melleni was observed in wild and cultured fish in all seasons, with a gradual increase in the number of parasites from the coldest to the hottest seasons, with the highest prevalence and mean intensity in the summer. Helicometrina nimia was found in all seasons in both wild and cultured fish, except for summer, where its presence was detected only in wild fish. Pseudempleurosoma sp. and larvae of Contracaecum sp. showed low prevalence occurring in wild and cultured fish in the autumn and spring, respectively. This study revealed high intensities of potentially pathogenic parasites that could favour disease outbreaks in culture conditions.

Este estudo teve como objetivo identificar e quantificar os parasitos da garoupa verdadeira Epinephelus marginatus selvagem e cultivada. Durante um ano, nas quatro estações, 20 garoupas selvagens e 20 cultivadas foram examinadas quanto à presença de parasitos, exceto na última estação, em que foram examinados 19 peixes selvagens e 20 cultivados, totalizando 159 peixes examinados em Ubatuba, Sudeste do Brasil. A prevalência, intensidade média de infecção, abundância média and dominância média relativa foram calculados. Cinco espécies de parasitos foram identificadas nos peixes de ambas as origens: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) e larvas de Contracaecum sp. (Nematoda). A prevalência de ectoparasitos foi, na maioria das vezes, maior do que a de endoparasitos. O parasito mais abundante foi o monogenea Pseudorhabdosynochus beverleyburtonae em ambos os peixes selvagens e cultivados, durante todas as estações. Neobenedenia melleni foi observado e, peixes selvagens e cultivados em todas as estações, com aumento gradativo no número de parasitos das estações mais frias para as mais quentes, com as maiores prevalências e intensidades médias no verão. Helicometrina nimia foi encontrado em todas as estações em ambos os peixes selvagens e cultivados, exceto no verão, em que foi observada sua presença apenas em peixes selvagens. Pseudempleurosoma sp. e larvas de Contracaecum sp. apresentaram baixas prevalências, ocorrendo em peixes selvagens e cultivados no outono e na primavera, respectivamente. Este estudo revelou altas intensidades de parasitos potencialmente patogênicos que podem favorecer surtos de doenças em situações de cultivo.

Apedunculata discoidea gen. n., sp. n. (Monogenea: Dactylogyridae) parasitic on Prochilodus lineatus (Valenciennes, 1837) (Characiformes: Prochilodontidae) from southeastern Brazil / Apeduncullata discoidea gen. n., sp. n. (Monogenea: Dactylogyridae) parasito de Prochilodus lineatus (Valenciennes, 1837) (Characiformes: Prochilodontidae) do sudeste do Brasil

A new species of dactylogyrid monogenean, Apedunculata discoidea gen. n., sp. n. is described and illustrated from the gills of the freshwater fish Prochilodus lineatus (Valenciennes, 1837) in pisciculture ponds from Pirassununga, São Paulo, Brazil. Diagnostic characters of the new genus and species are: 1) vagina dextrolateral slightly sclerotised, opening anteriorly at level of copulatory complex; 2) copulatory organ coiled with two counterclockwise rings; 3) Accessory piece distal and not articulated; 4) body disk-shaped, lacking a peduncle.

Uma espécie nova de monogenético dactilogirídeo, Apedunculata discoidea gen. n., sp. n. parasita das brânquias do peixe de água doce Prochilodus lineatus (Valenciennes, 1837) proveniente de pisciculturas de Pirassununga, São Paulo, Brasil, é descrita e ilustrada. As características diagnósticas do novo gênero e da nova espécie são: 1) vagina dextrolateral levemente esclerotizada, com abertura ao nível do complexo copulatório; 2) órgão copulatório em espiral com duas voltas no sentido anti-horário; 3) peça acessória distal e não articulada; 4) corpo com formato de disco e sem pedúnculo.

Community ecology of the metazoan parasites of namorado sandperches, Pseudopercis numida Miranda-Ribeiro, 1903 and P. semifasciata Cuvier, 1829 (Perciformes: Pinguipedidae), from the coastal zone of the State of Rio de Janeiro, Brazil / Ecologia da comunidade de metazoários parasitos dos namorados, Pseudopercis numida e P. semifasciata (Perciformes: Pinguipedidae), do litoral do estado do Rio de Janeiro, Brasil

One hundred and twenty-eight specimens of namorado sandperches, 62 P. numida and 66 P. semifasciata, collected between October 2002 and June 2003 off the Cabo Frio, Rio de Janeiro, Brazil (Lat 23° S and Long 42° W), were examined to study their metazoan parasites. Parasite communities of these fish were composed basically of endoparasites, mainly digenean and cestodes species, with low prevalence and abundance but having high parasite species richness values (at the component community level). Among these values, that found for P. numida is the highest so far recorded for marine fishes from the Neotropical Region. Thirty-nine species of metazoan parasites were collected: 36 from P. numida and 28 from P. semifasciata. Twenty-five parasite species were common to both species of namorado sandperches. Pseudopercis numida and P. semifasciata are new host records for all parasite species collected, with the exception of Microcotyle pseudopercis. Choanodera sp., Leurodera decora, Neolebouria georgenascimentoi, and Proctoeces sp. which were recorded for the first time in the South American Atlantic Ocean. Gnathia sp. from P. numida and Scolex pleuronectis from P. semifasciata were the species having the greatest dominance frequency. Parasite abundance in P. numida and P. semifasciata were positively correlated with the host total length. Only in P. numida was parasite species richness correlated positively with the host total length. No significant differences between endoparasite infracommunities of P. numida and P. semifasciata were detected. The ectoparasites of P. numida had higher values for parasite abundance, parasite richness, Brillouin index, evenness index, and Berger-Parker index than those of the ectoparasites of P. semifasciata. Comparisons among all ecto- and endoparasites showed the ectoparasites of P. numida as the most heterogeneous group. Low similarity values were observed among the three types of parasite infracommunities...

Cento e vinte e oito espécimes de namorados, 62 P. numida e 66 P. semifasciata, foram coletados entre Outubro de 2002 e Junho de 2003, provenientes de Cabo Frio, litoral do Estado do Rio de Janeiro, Brasil (Lat 23° S e Long 42° W), sendo necropsiados para estudo de seus metazoários parasitos. As comunidades parasitárias dos namorados foram compostas por espécies com baixa prevalência e abundância, mas caracterizadas por altos valores de riqueza de espécies (no nível de comunidade componente) e incluem basicamente endoparasitos, principalmente espécies de digenéticos e cestóides. A riqueza parasitária em P. numida foi registrada como a mais alta em peixes marinhos da região Neotropical. Trinta e nove espécies de metazoários parasitas foram coletadas: 36 em P. numida e 28 em P. semifasciata. Pseudopercis numida e P. semifasciata são novos registros de hospedeiros para todas as espécies coletadas com exceção de Microcotyle pseudopercis. As espécies Choanodera sp., Leurodera decora, Neolebouria georgenascimentoi e Proctoeces sp. foram registradas pela primeira vez no Oceano Atlântico Sul. Gnathia sp. em P. numida, e Scolex pleuronectis em P. semifasciata foram as espécies com maior freqüência de dominância. A abundância parasitária em P. numida e P. semifasciata foi correlacionada com o comprimento total dos hospedeiros. Apenas em P. numida a riqueza de espécies de parasitas estava correlacionada positivamente com o comprimento total do hospedeiro. As infracomunidades de ectoparasitos em P. numida tiveram valores mais altos na abundância parasitária, riqueza parasitária, índice de Brillouin, índice de uniformidade e Berger-Parker do que os ectoparasitos de P. semifasciata. Nenhuma diferença significativa entre as infracomunidades de endoparasitas foi detectada. Comparações entre ectoparasitos e endoparasitos amostrados indicaram os ectoparasitos de P. numida como o grupo mais heterogêneo. Baixos valores de similaridade foram observados entre...

Lista modelo de medicamentos de alto riesgo / A model list of high risk drugs

Introducción: Los «medicamentos de alto riesgo» son aquellos con un «riesgo» muy elevado de causar daños graves o incluso mortales cuando se produce un error en el curso de su utilización. El Institute for Safe Medication Practices (ISMP) elaboró una relación aplicable a la población general, sin diferenciar población pediátrica y adulta, por lo que existe carencia de información para la población pediátrica. El objetivo de este trabajo es elaborar una lista de medicamentos de alto riesgo adaptada a la población pediátrica y neonatal que sirva de referencia para el personal sanitario de un hospital pediátrico. Material y métodos: Se realizó una búsqueda bibliográfica en mayo del 2012 en las principales bases de datos biomédicas, para identificar posibles listas o referencias publicadas en relación con medicamentos de alto riesgo en población pediátrica y neonatal. Resultados: Se encontraron 15 trabajos, seleccionándose 9 para el objetivo principal del estudio. Se elaboró una lista guía tomando como base la del ISMP, añadiendo fármacos con alta percepción de riesgo para la población pediátrica y eliminando aquellos cuyo uso en pediatría era anecdótico. Conclusiones: No se encontró una lista publicada que se adaptase totalmente a nuestro objetivo. La lista de medicamentos de alto riesgo en población pediátrica y neonatal elaborada puede ser modelo de referencia para hospitales pediátricos. Su conocimiento y utilización, así como actividades derivadas de la misma enmarcadas dentro de la política de seguridad, ayudará a evitar errores de medicación en cada proceso de la cadena terapéutica (prescripción, transcripción, dispensación y administración) (AU)

Introduction: «High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. Material and methods: We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. Results: A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. Conclusions: There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration) (AU)

Piperacilina-tazobactam en perfusión continua o expandida frente a perfusión intermitente / Piperacillin-tazobactam in continuous or expanded perfusion vs intermittent perfusion

Objetivo: El objetivo principal de esta revisión es analizar las diferencias de eficacia entre la administración en perfusión intermitente y la administración en perfusión continua/expandida de piperacilina-tazobactam. Como objetivos secundarios se analizan las diferencias en seguridad, parámetros farmacocinéticos/farmacodinámicos y coste-efectividad entre las 2 formas de administración. Método Se realizaron 2 búsquedas bibliográficas independientes. Se encontraron un total de 38 artículos y finalmente se incluyeron en el estudio 6. Se analizaron los artículos incluidos y se recogieron las variables diseño, tratamiento administrado a cada grupo, número de pacientes total y perteneciente a cada grupo, variables recogidas en cada estudio y resultados. Resultados Se hallaron diferencias significativas en la variable principal en 2 de los 6 estudios incluidos a favor de la perfusión continua/expandida. En el estudio de Lodise et al. se encontraron diferencias (p = 0,04) en mortalidad (31,6% en perfusión intermitente vs 12,2% en perfusión continua/expandida). En el estudio de Lorente et al. se encontraron diferencias (p = 0,001) en curación clínica (56,5% perfusión intermitente vs 89,2% en perfusión continua/expandida). En cuanto a las variables secundarias solo se encontraron diferencias en uno de los estudios en la relación coste-efectividad a favor del grupo de perfusión continua/expandida. Conclusión Los datos analizados indican que la perfusión continua/expandida sería al menos igual de eficaz que la perfusión intermitente, y que podría ser más eficaz en pacientes más graves, o con infecciones por microorganismos más resistentes, como Pseudomonas aeruginosa. Además esta forma de administración es, en teoría, más coste-efectiva (AU)

Objective: The primary objective of this review was to analyse the differences in efficacy between the administration of intermittent and continuous/expanded perfusion of piperacillin-tazobactam. Secondary objectives were to analyse the differences in safety, pharmacokinetic/pharmacodynamic parameters, and cost-effectiveness between the two forms of administration. Method: We performed two different independent bibliographic searches. We encountered a total of 38 articles, and the final number included in the study was 6. We analysed the articles and collected the following variables: design, treatment administered to each group, total number of patients and number of patients in each study, variables collected in each study, and results. Results: We encountered significant differences in the primary variable in two of the six studies favouring continuous/expanded perfusion. The study by Lodise et al found differences (P=.04)in mortality (31.6% for intermittent perfusion vs 12.2% for continuous/expanded perfusion).The study by Lorente et al found differences (P=.001) in terms of clinical recovery (56.5% for intermittent perfusion vs 89.2% for continuous/expanded perfusion). As for secondary variables, we only found differences in one of the studies in relation to cost-effectiveness, in favour of the group who underwent continuous/expanded perfusion method. Conclusion: The analysed data suggest that continuous/expanded perfusion would be at least as effective as intermittent perfusion, and that it could be more effective in severe patients with infections from more resistant micro-organisms such as Pseudomonas aeruginosa. Additionally, this form of administration is more cost-effective, at least in theory (AU)

Septicemia y celulitis por Vibrio vulnificus en paciente cirrótico / Sepsis and cellulitis by Vibrio vulnificus in cirrhotic patient

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Estudio sobre la función sexual de pacientes que inician tratamiento con aripiprazol. Estudio naturalístico, abierto, prospectivo y multicéntrico / Observational, Open-Label, Prospective Multicenter Study of Sexual Function in Patients Starting Treatment with Aripiprazole

Introducción. El tratamiento con neurolépticos puede asociarse a disfunción sexual secundaria. Los estudios sobre la disfunción sexual secundaria a antipsicóticos son importantes para poder establecer la eficiencia de estos fármacos en los tratamientos crónicos. El objetivo principal de este estudio ha sido valorar de forma prospectiva si el aripiprazol produce modificaciones en la función sexual de los pacientes con esquizofrenia 3 meses después de su instauración. Métodos. El análisis de eficacia se efectuó en dos poblaciones, la población para intención de tratamiento (41pacientes) y la población por protocolo (36 pacientes). El análisis de seguridad se ha realizado en la muestra total (42 pacientes). Resultados. Incidencia nula de disfunción sexual a los 3 meses de tratamiento con aripiprazol, tanto en los pacientes que recibían aripiprazol como primer antipsicótico como en los que habían cambiado a aripiprazol debido a una falta de eficacia de otro antipsicótico. Además de producir una mejoría de los síntomas de psicosis (escala BPRS), el aripiprazol disminuyó la puntuación en la escala SALSEX, siendo el retraso en la eyaculación u orgasmo el que presentó una mejoría media más marcada. Conclusiones. Mejoría global del funcionamiento sexual durante los 3 meses de tratamiento con aripiprazol, que muestra una recuperación más rápida en los hombres que en las mujeres, aunque ambos consiguen una recuperación similar (AU)

Introduction. Treatment with neuroleptics maybe associated with secondary sexual dysfunction. Studies of sexual dysfunction induced by antipsychotic are important to establish the effectiveness of these agents in patients taking chronic treatments. The main objective of this study was to evaluate prospectively whether a 3 month course of aripiprazole produces changes in the sexual function of patients with schizophrenia. Methods. The efficacy analysis was performed in the intention-to-treat population (41 patients) and the perprotocol population (36 patients). The safety analysis was based on the total sample (42 patients). Results. The incidence of sexual dysfunction after 3months of treatment with aripiprazole was zero both in patients who switched therapy due to lack of efficacy and in those taking aripiprazole as a first antipsychotic. Aripiprazole led to an improvement in the symptoms of psychosis (score on the BPRS) and lower scores on the-SALSEX questionnaire. The most remarkable improvement was in delayed eyaculation /orgasm. Conclusion. During the 3 months of treatment, we observed an overall improvement in sexual performance, with a quicker recovery in men than in women, although recovery was similar in both at the end of treatment (AU)

Community ecology of metazoan parasites of the anchovy Anchoa tricolor (Osteichthyes: Engraulidae) from the coastal zone of the State of Rio de Janeiro, Brazil

Entre outubro de 2001 e março de 2002, foram examinados 103 espécimes de A. tricolor provenientes de Angra dos Reis (23º01'S, 44º19'W), litoral do Estado do Rio de Janeiro, Brasil, para o estudo de suas infracomunidades de metazoários parasitos. Foram coletadas 10 espécies de metazoários parasitos: 4 digenéticos, 1 cestóide, 1 acantocéfalo, 2 nematóides, 1 copépode e 1 hirudíneo; e 77% dos peixes estavam parasitados por 1 ou mais metazoários, com média de 3,5 ± 6,2 parasitos/peixe. Os digenéticos foram dominantes, representando 53,2% do total de parasitos coletados, e Ergasilus sp., a espécie mais abundante. A abundância e a prevalência de Parahemiurus merus (Linton, 1910) foram positivamente correlacionadas ao comprimento total dos hospedeiros. Relações entre a abundância parasitária total e a riqueza parasitária média ao comprimento total dos hospedeiros foram observadas. A diversidade parasitária média foi corrrelacionada com o comprimento total dos hospedeiros, apresentando diferenças significativas entre os peixes machos e fêmeas. Dois pares de espécies de larvas apresentaram associação e covariação positiva significativas. As infracomunidades de metazoários parasitos de A. tricolor demonstraram dominância nas larvas de endoparasitos, correlação entre abundância parasitária, diversidade e riqueza de espécies e o comprimento total dos hospedeiros e o baixo número de associações interespecíficas parasitárias. A comunidade parasitária de A. tricolor apresentou algumas semelhanças com a comunidade parasitária de outros engraulídeos do Atlântico Sul-Americano.

Community ecology of the metazoan parasites of Atlantic Moonfish, Selene setapinnis (Osteichthyes: Carangidae) from the coastal zone of the state of Rio de Janeiro, Brazil

Foram coletados 89 espécimes de Selene setapinnis (Mitchill, 1815) no litoral do Estado do Rio de Janeiro (21-23ºS, 41-45ºW e 23º05'S, 44º30'W), Brasil, de agosto de 2001 a maio de 2002, os quais foram necropsiados para o estudo de seus metazoários parasitos. Foram encontrados 81 (91%) espécimes de S. setapinnis parasitados por uma ou mais espécies de metazoários parasitos, sendo coletados 21 espécies de parasitos: 8 digenéticos, 3 monogenéticos, 2 cestóides, 5 nematóides e 3 copépodes. Os endoparasitos (digenéticos, cestóides e nematóides) somam 74,1% do número total de espécimes de parasitos coletados. O monogenético Pseudomazocraes selene (Hargis, 1957) foi a espécie mais dominante e com maior valor de prevalência na comunidade parasitária de S. setapinnis. Os metazoários parasitos deste hospedeiro mostraram o típico padrão agregado de distribuição. Apenas uma espécie de parasito (Acanthocolpoides pauloi Travassos, Freitas & Bührnheim, 1955) mostrou correlação positiva entre o comprimento total do hospedeiro e a abundância parasitária. Caligus robustus Bassett-Smith, 1898, P. selene e Terranova sp. tiveram correlação positiva entre o comprimento total do hospedeiro e a prevalência parasitária. Larvas de Terranova sp. mostraram influência do sexo do hospedeiro sobre sua prevalência parasitária. Apenas um par de espécies de ectoparasitos, P. selene-C. robustus, mostraram covariação positiva entre suas abundâncias. Dois pares de espécies de endoparasitos, L. microstomum-P. merus e A. pauloi-P. merus mostraram covariação positiva entre suas abundâncias; e o par Terranova sp.-Raphidascaris sp. teve co-ocorrência e covariação positiva nas infracomunidades de S. setapinnis. Como nas outras comunidades parasitárias de peixes carangídeos do Rio de Janeiro, a comunidade parasitária de S. setapinnis aparentemente é um complexo de espécies pouco ordenado, caracterizado pela dominância de endoparasitos.