ABSTRACT
Probiotics are live microorganisms that benefit the host in different clinical situations. Bacillus clausii is one of the most frequently used, but it is not without risk. To date, there are few reports of complications secondary to this agent in pediatric patients. OBJECTIVE: To describe the case of an infant who developed after treatment sepsis due to Bacillus clausii. CLINICAL CASE: A 4-month-old female infant of indigenous ethnicity, from a rural area in the interior of Panama, 3 hours away from the nearest health sub-center by canoe, and with protein-calorie malnutrition, presented with acute diarrhea and moderate-severe dehydration, receiving Enterogermina as part of the initial treatment. She was transferred to a tertiary hospital, where she arrived with impaired consciousness, respiratory distress, and signs of shock. The initial blood culture reported growth of methicillin-resistant Staphylococcus aureus (MRSA), the gastrointestinal panel was positive for Clostridiodes difficile, and later serial blood cultures of peripheral blood and central venous catheter confirmed growth of Bacillus clausii. With a torpid evolution and resistance to multiple antibiotic schemes, she died due to multisystem organ failure twelve days after admission. CONCLUSIONS: The use of probiotics as concomitant treatment in patients with some degree of immunosuppression should be administered with caution, considering the presence of risk criteria for complications such as malnutrition or intestinal epithelial damage due to severe diarrhea since they predispose to the development of bacteremia and/or sepsis.
Subject(s)
Bacillus clausii , Methicillin-Resistant Staphylococcus aureus , Probiotics , Sepsis , Female , Humans , Infant , Diarrhea , Probiotics/adverse effects , Sepsis/complications , Sepsis/therapyABSTRACT
BACKGROUND AND AIMS: The progression of nonalcoholic fatty liver disease (NAFLD) into severe histological forms (steatohepatitis - NASH) is paralleled by the occurrence of complex molecular processes. Mitochondrial dysfunction is a hallmark feature of advanced disease. Mitochondrially encoded cytochrome B (cytochrome b, MT-CYB), a member of the oxidative phosphorylation system, is a key component of the respirasome supercomplex. Here, we hypothesized that NAFLD severity is associated with liver tissue cytochrome b mutations and damaged mitochondrial DNA (mtDNA). METHODS: We included 252 liver specimens of NAFLD patients - in whom histological disease ranged from mild to severe - which were linked to clinical and biochemical information. Tissue molecular explorations included MT-CYB sequencing and analysis of differential mtDNA damage. Profiling of circulating Krebs cycle metabolites and global liver transcriptome was performed in a subsample of patients. Tissue levels of 4-hydroxynonenal - a product of lipid peroxidation and 8-hydroxy-2'-deoxyguanosine, a marker of oxidative damage - were measured. RESULTS: Compared to simple steatosis, NASH is associated with a higher level of MT-CYB variance, 12.1 vs. 15.6 substitutions per 103 bp (P = 5.5e-10). The burden of variants was associated with increased levels of 2-hydroxyglutarate, branched-chain amino acids, and glutamate, and changes in the global liver transcriptome. Liver mtDNA damage was associated with advanced disease and inflammation. NAFLD severity was associated with increased tissue levels of DNA oxidative adducts and lipid peroxyl radicals. CONCLUSION: NASH is associated with genetic alterations of the liver cellular respirasome, including high cytochrome b variation and mtDNA damage, which may result in broad cellular effects.
Subject(s)
Cytochromes b/genetics , DNA Damage , DNA, Mitochondrial , Liver/metabolism , Non-alcoholic Fatty Liver Disease/genetics , Non-alcoholic Fatty Liver Disease/metabolism , 8-Hydroxy-2'-Deoxyguanosine/blood , Adult , Aged , Aldehydes/blood , Amino Acids, Branched-Chain/blood , Disease Progression , Glutamic Acid/blood , Glutarates/blood , Humans , Lipid Peroxidation , Middle Aged , Mutation , Non-alcoholic Fatty Liver Disease/complications , Obesity/complications , Obesity/genetics , Obesity/metabolism , Oxidative Phosphorylation , Oxidative Stress , Severity of Illness Index , TranscriptomeABSTRACT
El test de micronúcleos (MN) es un biomarcador de genotoxicidad no destructivo que permite detectar daño cromosómico y otras alteraciones nucleares (AN). Phrynops hilarii es un quelonio de agua dulce que habita regiones del centro-norte de Argentina. El objetivo principal fue determinar la presencia de MN y otras AN en eritrocitos de poblaciones naturales de P. hilarii comparando sus frecuencias entre tres sitios, dos antropizados y uno de control (ciudades de Diamante y Paraná) de Entre Ríos, Argentina, durante el periodo 2015-2016. Dieciocho individuos (seis por sitio de muestreo) fueron evaluados en los sitios: 1- PD: Parque Nacional Pre-Delta (control), 2- AG: Salto Ander Egg (agroecosistema) y 3- SU: Caleta Club Náutico (sistema urbano). Se extrajo sangre de la vena femoral. Las muestras se tiñeron con el método May Grünwald-Giemsa y se observaron bajo un microscopio con el objetivo de inmersión. Las frecuencias de micronúcleos (FMN) y alteraciones nucleares (FAN) se determinaron cada 1000 eritrocitos observados. Se encontró diferencia significativa (p<0,05) entre el sitio PD y los otros sitios (AG y SU), tanto para FMN (p=0,0021) como para FAN (p=0,0011). Los valores de las frecuencias más altos correspondieron al sitio AG (FMN: 3,33±0,62; FAN: 4,67±0,56). Finalmente, el biomonitoreo con P. hilarii fue útil, por lo que podría considerarse como especie bioindicadora para evaluar la calidad de los ambientes de Argentina.
The micronucleus test (MN) is a biomarker of non-destructive genotoxicity that allows chromosomal damage and other nuclear alterations (NA) to be detected. Phrynops hilarii is a freshwater chelonium that inhabits regions of central-northern Argentina. The main objective was to determine the presence of MN and other NA in erythrocytes of natural populations of P. hilarii comparing their frequencies between three sites, two anthropized and one of control (cities of Diamante and Paraná) of Entre Ríos, Argentina, during the period 2015-2016. Eighteen individuals (six per sampling site) were evaluated at the sites: 1- PD: Pre-Delta National Park (control), 2- AG: Salto Ander Egg (agroecosystem) and 3- SU: Caleta Club Náutico (urban system). Blood was obtained from the femoral vein. The samples were stained with the May Grünwald-Giemsa method and observed under a microscope with an immersion objective. Micronucleus (MNF) and nuclear alterations (NAF) frequencies were determined every 1000 erythrocytes observed. A significant difference (p<0.05) was found between the PD site and the other sites (AG and SU), both for MNF (p=0.0021) and for NAF (p=0.0011). The highest frequency values corresponded to the AG site (MNF: 3.33 ± 0.62; NAF: 4.67 ± 0.56). Finally, biomonitoring with P. hilarii was useful, so it could be considered as a bioindicator species to assess the quality of Argentina's environments.
ABSTRACT
El sarampión una enfermedad que en el siglo IX (860-932)fue descrita por el médico persa Muhammad ibn Zacariya al-Razi quien la diferenció de la viruela por sus síntomas y signos clínicos .
Subject(s)
Measles/epidemiology , Measles Vaccine , Disease Outbreaks , Measles/transmissionABSTRACT
Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.
Subject(s)
Calcitonin/blood , Fever/diagnosis , Infections/diagnosis , Lipopolysaccharide Receptors/blood , Lupus Erythematosus, Systemic/complications , Neutrophils/chemistry , Peptide Fragments/blood , Receptors, IgG/blood , Systemic Inflammatory Response Syndrome/blood , Adult , Biomarkers/blood , Cross-Sectional Studies , Diagnosis, Differential , Female , Fever/blood , Humans , Immunosuppressive Agents/therapeutic use , Infections/blood , Lupus Erythematosus, Systemic/blood , Male , Middle AgedABSTRACT
La pediatría social se debe ejercer siempre que nos encontremos con niños que tienen problemas que afecten la salud cuyo origen y causalidad deriven de problemas en la sociedad
Subject(s)
Social Medicine/organization & administration , PediatricsABSTRACT
BACKGROUND: Previous epidemiological studies suggest that patients diagnosed with nonalcoholic fatty liver disease (NAFLD) who drink light to moderate amounts of alcohol (up to ~30 g per day) have less severe histological lesions compared with nondrinkers. However, while the cross-sectional nature of current evidence precludes assessment of causality, cumulative lifetime-exposure of moderate alcohol consumption on histological outcomes has never been evaluated. AIM: To overcome these limitations, a Mendelian randomisation study was performed using a validated genetic variant (rs1229984 A;G) in the alcohol dehydrogenase (ADH1B) gene as a proxy of long-term alcohol exposure. METHODS: We first assessed whether the instrumental variant (rs1229984) was associated with the amount of alcohol consumption in our cohort. We further explored the association between the variant and histological outcomes; a sample of 466 individuals, including 266 patients with NAFLD confirmed by liver biopsy, was studied. RESULTS: We found that carriers of the A-allele consumed significantly lower amounts of alcohol compared with noncarriers (2.3 ± 5.3 vs. 8.18 ± 21 g per day, mean ± s.d., P = 0.03). The analysis of association with the disease severity showed that carriers of the A-allele had lower degree of histological steatosis (1.76 ± 0.83 vs. 2.19 ± 0.78, P = 0.03) and lower scores of lobular inflammation (0.54 ± 0.65 vs. 0.95 ± 0.92, P = 0.02) and NAFLD-Activity Score (2.9 ± 1.4 vs. 3.7 ± 1.4, P = 0.015) compared with noncarriers. CONCLUSION: Mendelian randomisation analysis suggests no beneficial effect of moderate alcohol consumption on NAFLD disease severity.
Subject(s)
Alcohol Dehydrogenase/genetics , Alcohol Drinking/genetics , Non-alcoholic Fatty Liver Disease/genetics , Non-alcoholic Fatty Liver Disease/pathology , Adult , Aged , Alleles , Biopsy , Female , Genetic Variation , Humans , Male , Mendelian Randomization Analysis , Middle AgedABSTRACT
El virus respiratorio sincicial es un mixovirus RNA, del género Pneumovirus, de la familia de los Paramyxoviridae , es reconocido como una importante causa de infección aguda del tracto respiratorio superior leve o severo como bronquiolitis y neumonía, en especial en niños menores de 5 años1. Las infecciones por Virus sincicial respiratorio (VSR) induce una respuesta parcial inmune que no confiere una protección a largo tiempo, por lo que las infecciones repetidas por este virus son comunes. Se ha estimado que las infecciones por VSR causa 3.4 millones de hospitalizaciones de niños a nivel mundial. De acuerdo a su variabilidad antigénica y genética el VSR es clasificado en dos subgrupos en VSR-A y VSR-B. Virus sincicial respiratorio tipo A2: Incluye las mayores cepas epidémicas y tienen por lo menos siete genotipos (GA1-7), la co-circulación de diferentes de RSV-A fue considerada la causa de infecciones repetidas y de brotes.
ABSTRACT
Presentamos el primer caso confirmado de neonato con microcefalia relacionado a Zika en Panamá, quien además presentaba lesión a nivel del occipucio compatible con encefalocele.
We report the first confirmed case of newborn with microcephaly related with Zika in Panama, who also had lesions to the occiput compatible with encephalocele.
ABSTRACT
La meningitis recurrente es una entidad rara que sugiere la presencia de una comunicación adquirida o congénita entre el liquido cefalorraquídeo y las áreas mucocutáneas adyacentes. Presentamos el caso de una paciente de 11 meses con historia de meningitis recurrente (4 episodios) asociadas a hipoacusia neurosensorial y otorrea intermitente en la que se diagnóstico fístula del LCR en oído interno así como una malformación secular cócleo-vestibular compatible con displasia de Mondini. Ante cuadros recurrentes de meningitis bacteriana en la edad pediátrica y más aún, si padece hipoacusia neurosensorial como en nuestro caso, es necesario agotar todas las posibilidades diagnósticas de forma precoz y oportuna en busca de malformaciones. En especial las fístulas congénitas que frecuentemente se les asocian y que con una temprana intervención quirúrgica puede evitar futuros episodios.
Recurrent meningitis is a rare but severe entity which suggests the presence of an acquired or congenital communication between of cerebrospinal fluid and adjacent mucocutaneous sites. We present the case of an 11 month patient with history of recurrent meningitis ( 4 episodes), associated to neurosensorial hipoacusia and intermittent otorrhea in which a diagnosis of cerebrospinal fluid fistula in the middle ear as well as a secular cochlea-vestibular malformation, compatible with Mondini dysplasia was made. In the presence of recurrent bacterial meningitis in the pediatric age, moreover if the patient suffers hearing impairment as in our case, it is necessary to exhaust all diagnostic possibilities early and timely in search of malformations, especially congenital fistulas, as they are associated and prompt surgical intervention may prevent futher episodes.
ABSTRACT
Guía de actualización de Zika describiendo hallazgos clínicos, métodos diagnósticos y manejo.
Zika update guide describing clinical findings, diagnostic methods and management.
ABSTRACT
BACKGROUND: The prevalence of obesity, as well as evidence about this pathology as a risk factor for cognitive decline and dementia in the elderly, is increasing worldwide. Executive functions have been found to be compromised in most studies, although the specific results are dissimilar. Obese young women constitute an interesting study and intervention group, having been found to be unaffected by age and hormonal negative effects on cognition and considering that their health problems affect not only themselves but their families and offspring. The objective of the present study was to compare the executive performance of obese young women with that of a healthy control group. METHODS: A cross-sectional study was done among premenopausal women from a public hospital in Buenos Aires. The sample comprised 113 participants (32 healthy controls and 81 obese women), who were evaluated for depressive and anxiety symptoms (Beck Depression Inventory-II and State-Trait Anxiety Inventory) and executive functioning (Trail-Making Test B, Stroop Color and Word Test, Wisconsin Card Sorting Test, and verbal fluency test). Statistical analysis was done by using the SPSS version 20.0 software. RESULTS: Among executive functions, a significant difference was found between groups in inhibition (p<0.01). No correlation was found between psychopathologic measures and Stroop Test Interference results. We found slight correlations between Stroop Test Interference results, waist circumference, fat mass and HDL-cholesterol. In obese group, there was a negative slightly correlation between this cognitive test and 2h post-load glucose level. CONCLUSIONS: Inhibition was decreased in our obese young women group, and glucose/lipid metabolism may be involved in this association. The cognitive impairment is comparable with that described in addictive conditions. Our conclusions support the concept of multidisciplinary management of obese patients from the time of diagnosis. Detecting and understanding cognitive dysfunction in this population is essential to providing appropriate treatment.
Subject(s)
Cognition Disorders/etiology , Inhibition, Psychological , Metabolic Diseases/etiology , Obesity/complications , Obesity/metabolism , Adult , Cholesterol/metabolism , Cross-Sectional Studies , Executive Function/physiology , Fats/metabolism , Female , Humans , Neuropsychological Tests , Psychiatric Status Rating Scales , Retrospective StudiesABSTRACT
El dengue es una infección vírica (familia Flaviviridae, virus ARN) transmitida por la picadura de las hembras infectadas de mosquitos del género Aedes. Hay cuatro serotipos de virus del dengue (DEN 1, DEN 2, DEN 3 y DEN 4)1. Epidemiologia y transmisión La enfermedad es ahora endémica en más de 100 países en África, América, Mediterráneo oriental, el sudeste de Asia y el Pací co occidental y aproximadamente 2,5 billones de personas están en riesgo (dos quintas partes de la población mundial2. Alrededor del 40% de la población mundial vive en áreas endémicas y decenas de millones de personas se infectan cada año. La incidencia anual estimada es de 50 millones de casos de dengue, con probablemente unos 500 000 pacientes hospitalizados por DHF-SSD (fundamentalmente, niños) y una mortalidad de hasta el 5% en determinadas áreas3. El ciclo natural de la infección se establece entre el hombre y varias especies de mosquitos del género Aedes, subgénero Stegomyia, en especial A. aegypti y A.albopictus (ahora conocidos como Stegomyia aegypti y Stegomyia albopicta). Existe otro ciclo menos conocido, el selvático, cuyo reservorio son los primates no humanos. Se ha con rmado la transmisión vertical del dengue.
ABSTRACT
La tuberculosis (TB) continúa siendo una enfermedad muy presente en nuestros días, incluido entre la población pediátrica, y con una fuerte asociación con el VIH. A pesar de los esfuerzos realizados para el control de la enfermedad, es una importante causa de morbimortalidad en algunos países. La dificultad para confirmar el diagnóstico y la variedad en las formas de presentación, conducen a una baja noti cación. La OMS reportó en 2013, una incidencia mundial de 9 millones de casos, en el 2011 se reportaron 500.000 casos en menores de 15 años, y 64.000 fallecimientos en población pediátrica por tuberculosis (pacientes no infectados por VIH) y para el 2013 se reportaron 80,000 defunciones en niños infectados por VIH y tuberculosis. En 2013 se diagnosticaron 480,000 nuevos casos a nivel mundial de tuberculosis multiresistente (MDR resistentes por lo menos a rifampicina e isoniacida) y tuberculosis extremadamente resistente a drogas (XDR resistentes a rifampicina, isoniacida más una uroquinolona y por lo menos a una de las tres drogas de segunda línea inyectable como amikacina, kanamicina y capreomicina)
ABSTRACT
El Citomegalovirus (CMV), es un virus de baja contagiosidad perteneciente a la familia de los Herpervirus junto con el virus de Epstein-Barr (VEB), virus herpes tipo 1 y 2 (VHS 1 y 2) y virus de varicela zóster (VVZ)1 y es también conocido como Herpesvirus humano 5 (HHV-5). Es un virus ubicuo y altamente distribuido a nivel mundial, afectando a un gran número de individuos sin predominio de raza, sexo o edad. La infección por CMV es generalmente asintomática o cursa de forma muy leve, salvo en neonatos y pacientes inmunocomprometidos. Debido a la alta morbilidad y la gravedad de la infección de este grupo de pacientes, se hace imperante la sospecha y con rmación diagnóstica.
ABSTRACT
El autismo se conoce como un complejo desorden del neuro-desarrollo caracterizadas por dificultades cualitativas de interacción social, evitan el contact visual, con falta de empatía y reciprocidad social, incapacidad para reconocer y responder a gestos y expresiones.
Subject(s)
Humans , Animals , Infant , Child , Autistic Disorder , Social InteractionABSTRACT
Se presenta caso de paciente masculino de 14 años con diagnóstico de VIH, con evento adverso de nefrotoxicidad ( falla renal aguda o Síndrome de Fanconi ) asociado a tratamiento antirretroviral con Tenofovir (TDF)
Case of male patient of 14 years diagnosed with HIV, presents with adverse event of nephrotoxicity ( acute renal failure or Fanconi syndrome) associated with antiretroviral treatment Tenofovir ( TDF).
ABSTRACT
Paciente femenina de 14 años, quien presenta cuadro de disuria hace 48 horas y polaquiuria, hematuria franca, tenesmo vesical y heces sueltas de 3 horas de evolución, asociado a nausea y fiebre de 39 º C. Con cuadro de resfriado común dos semanas previa. Antecedente de trasplante de médula ósea hace dos meses. Los laboratorios revelan hematuria > 200 eritrocitos por campo, albumina 2 +, leucocitos 10-15 por campo, nitritos negativo. La función renal, hepática y la biometría hemática dentro de límites normales. Carga Viral por CMV negativa. Urocultivo negativo. Urocat: sin patologías.
ABSTRACT
Los trastornos del sueño en la niñez y en la adolescencia son comunes, pero a menudo se pasan por alto y son poco diagnosticados en la población pediátrica en nuestras consultas, por falta de conocimiento o capacitación del pediatra1. Es un problema que se reporta entre un 10-33% de la población pre-adolescente. Pueden afectar la salud física, como el desarrollo emocional, cognitivo y social2 Los trastornos del sueño son clasificados en disomnias y parasomnias. Las disomnias son trastornos primarios de inicio o mantención del sueño o de somnolencia excesiva y se caracterizan por una alteración en la cantidad, calidad, o el momento de dormir. (Ejm: insomnio, narcolepsia, apnea del sueño) Las parasomnias son trastornos de la conducta durante el sueño asociado con episodios breves o parciales de despertar, sin que se produzca una interrupción importante del sueño, ni una alteración del nivel de vigilia diurno (Ejm: sonambulismo, somniloquia,terror nocturno, bruxismo y enuresis nocturna).
