ABSTRACT
Background: Since 2010, several cases of a new vasculopathy induced by the use of levamisole-adulterated cocaine (LAC) have been reported. This vasculopathy is characterized by retiform purpura, earlobe necrosis, multisystem compromise, and multiple autoantibodies. Given its similarity to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, LAC-associated vasculopathy is postulated to be mediated by pathophysiologic processes resulting from neutrophil cell death by NETosis, a phenomenon previously described in ANCA vasculitis. This study tries to establish the presence of NETosis induced by cocaine, levamisole, or both. Methodology. Neutrophils were isolated from the peripheral blood of healthy controls by Ficoll-Hystopaque density gradient centrifugation followed by dextran sedimentation. Cell viability and purity were evaluated by flow cytometry after staining with PI/DiOC6 and labeling with fluorescent anti-CD45/anti-CD3 monoclonal antibodies (mAbs), respectively. Neutrophils were exposed to levamisole, cocaine, a cocaine-levamisole mixture, and sera pools from healthy controls and patients with LAC-associated vasculopathy. NETosis was then assessed by flow cytometry after staining cells with Sytox Green, Hoechst-33342, and fluorescent antineutrophil elastase (NE) and antimyeloperoxidase (MPO) mAbs. In addition, NETosis was morphologically confirmed by fluorescence microscopy. Proinflammatory cytokine levels in culture supernatants and reactive oxygen species (ROS) synthesis were determined by flow cytometry. The involvement of calcium and muscarinic receptors in cell death induction was evaluated in parallel experiments carried out in the presence of 1,2-bis (o-aminophenoxy) ethane-N, N, N', N'-tetraacetic acid (BAPTA) and hyoscine butylbromide (HBB), their respective inhibitors. Results: Cocaine, levamisole, and a cocaine-levamisole mixture induced neutrophil cell death. DNA/MPO extrusion and cell morphology patterns were consistent with NETosis. Neither proinflammatory cytokines nor ROS behaved as proNETotic factors. Preliminary results suggested that muscarinic receptors and calcium-dependent signals were involved in LAC-induced NETosis. Conclusions: Cocaine, levamisole, and a cocaine-levamisole mixture can induce NETosis through mechanisms involving muscarinic receptors and calcium-dependent pathways.
ABSTRACT
La parálisis del nervio facial o del VII par craneal, es una de las neuropatías más frecuentes. Se describe el caso de un paciente con parálisis facial periférica bilateral, secundaria a conmoción cerebral con fractura de base de cráneo y fractura temporal, a quien se le realizó tratamiento médico con esteroides sin mejoría, por lo que se decidió hacerle descompresión quirúrgica del nervio facial, con posterior resolución del cuadro clínico.
Facial nerve palsy is one of the most common neuropathies. The case of a bilateral facial nerve palsy is presented, secondary to cerebral commotion, cranial base and temporal fractures and was initiated on steroids with no signs of improvement, then a surgical decompression of the facial nerve was carried out with subsequent resolution of symptoms.
Subject(s)
Humans , Facial Paralysis , Brain Concussion , Fractures, Bone , Facial NerveABSTRACT
Objetivos: describir características de las traqueostomías realizadas en niños, en el Hospital Pablo Tobón Uribe de Medellín, Colombia y compararlo con la literatura mundial. Diseño: descriptivo retrospectivo. Métodos: se revisaron 38 historias de niños traqueostomizados, del 1 octubre de 2001 al 30 junio de 003.Resultados: el 60,52 por ciento fueron varones; el 13,15 por ciento menores de 1 año y el 34,21 por ciento con edades entre 1 y 5 años. La principal causa de ingreso fueron enfermedades del sistema respiratorio (28,9 por ciento). La principal indicación fue la intubación prolongada (71,1 por ciento). No se presentaron complicaciones intraoperatorias ni en las primeras 24 horas. En la primera semana 14/38 (37 por ciento) pacientes presentaron alguna complicación siendo la complicación más frecuente la decanulación accidental. No se reportaron muertes como consecuencia del procedimiento. Conclusiones: la traqueotomía en niños es un procedimiento seguro, con baja morbimortalidad como lo muestra nuestro trabajo y la literatura mundial.
Objectives: Describe the characteristics of pediatric tracheostomies performed at Pablo Tobón Uribe Hospital in Medellin, Colombia and compare the results with the ones in the world literature. Study design: retrospective descriptive. Methods: The charts of 38 children, who had undergone tracheostomy between the 1st of October 1999 and the 30th of June, 2003. Results: 60.52 percent of the patients were male. 13,15% of the procedures were performed in children under 1 year of age and 34,21 percent were performed on children between 1 and 5 years of age. The main cause to be admitted at the hospital was alterations to the Respiratory Tract (28,9 percent). The main indication was the long intubation period (71,1 percent). There were no intra operatory complications or during the first 24 hours. 14/38 (37 percent) of the patients exhibited some complications during the first week and the most frequent complication was an accidental decannulation. No deaths were reported as a consequence of the procedure. Conclusions: pediatric tracheostomy is a safe procedure, with low morbidity and mortality, as shown in our paper and the world literature.
