Pontine Myelinolysis Caused by Hypovolemic Hypernatremia.

Introduction. Central pontine myelinolysis is characterized by the occurrence of acute demyelinating lesions of cells in the pons secondary to abrupt oscillations of serum osmolarity. Its exact incidence is not well defined, but studies show a prevalence of 0.25 to 0.5% in the general population, 2.5% in the intensive care unit, and up to 10% in patients with risk factors, such as chronic liver disease and hepatic transplantation, alcoholism, malnutrition, diuretic therapy, electrolyte imbalance, hypoglycemia, and hyperglycemia. Case Report. A 70-year-old white female with extranodal diffuse large B-cell non-Hodgkin's lymphoma (extensive mass on the left anterior chest wall), stage IVA, developed pontine myelinolysis secondary to hypovolemic acute hypernatremia, which occurred due to diarrhea caused by chemotherapy (rituximab, cyclophosphamide, doxorubicin, and vincristine). Discussion. Pontine myelinolysis occurs most often due to the rapid correction of chronic hyponatremia. But here, we describe a case of the disease secondary to the occurrence of hypovolemic acute hypernatremia in a patient with a hematological malignancy under treatment, who was on chronic treatment with thiazide diuretics and who presented with other electrolyte disturbances as risk factors for the development of pontine myelinolysis.

Cognitive Breastfeeding Counseling: A Single Session Helps Improve LATCH Score.

Antenatal counseling improves the rate of exclusive breastfeeding. But routine antenatal counseling may not be effective in achieving this. Cognitive behavioral therapy derived techniques may be more useful in improving breastfeeding outcomes. We did this study to test the effectiveness of a single session of cognitive counseling compared to routine counseling in the third trimester for improving LATCH score. Fifty mother-baby dyads were enrolled. Twenty-six mothers underwent cognitive counseling and 24 mothers underwent routine counseling. After birth, the LATCH scores were assessed within the first 24 hours in the newborn. A single session of cognitive breastfeeding counseling in the third trimester is effective in significantly improving the LATCH scores in the immediate newborn period.

Long-term immune and virological response in HIV-infected patients receiving antiretroviral therapy.

WHAT IS KNOWN AND OBJECTIVE: The trajectory of HIV viral load and CD4 count and the occurrence of clinical events are primary considerations in the evaluation of antiretroviral therapy (ART) success or failure, yet a large number of studies do not describe these events from the point of therapy initiation. This study aims to describe the virological and immune response to ART and factors associated with immune and virological success in outpatients from a HIV/AIDS clinic in southern Brazil from therapy initiation. METHODS: Longitudinal observational with ambidirectional data collection study with adult patients followed for at least 12 months after enrolment. Outcomes include (i) favourable immune response, defined as CD4 count ≥200 cells/mm³; and (ii) virological success, defined as viral load below the limit of detection (50 copies/mL). RESULTS: The study included 332 patients, mostly men (63%), whose mean age was 40 (±10) years and with median family income of BR$ 490·00 per month (IQR: 350-875). Before starting ART, 43% of patients had indications of stable immune status (CD4 count ≥200 cells/mm³); the median CD4 count was 179 cells/mm³ (IQR: 93·5, 267) and increased to 379·5 cells/mm³ (IQR: 236·5, 591·3). The proportion of patients with CD4 count ≥200 cells/mm³ increased from 76% to 83%, and with undetectable viral load (UVL) increased from 51·7% to 73%. Factors associated with immune success at the end of study follow-up were as follows: female gender, pretreatment CD4 count ≥200 cells/mm³, previous UVL (measured when started prospective follow-up) and treatment with three drugs compared with ≥4. Factors associated with virological success were as follows: UVL (measured when started prospective follow-up) and use of three drugs compared with ≥4. WHAT IS NEW AND CONCLUSIONS: Results of this study show that a large proportion (73%) of patients have rapid and successful immune and virological responses to ART and that factors which predict this response include starting ART early, whereas viral load is low and CD4 count is high, with fewer drugs. These results further support the ongoing need for ongoing programmes to increase early HIV testing, early linkage to and treatment with ART, and increased viral suppression.

Pharmaceutical interventions in antiretroviral therapy: systematic review and meta-analysis of randomized clinical trials.

WHAT IS KNOWN AND OBJECTIVE: High levels of adherence to antiretroviral therapy (ART) are needed to achieve the desired results. Because pharmaceutical care might contribute to improved adherence to treatment, the aim of this study was to assess the impact of pharmaceutical interventions on ART via a systematic review of randomized clinical trials (RCT). METHODS: Study selection, data extraction and risk-of-bias assessment were performed independently by two reviewers. RESULTS AND DISCUSSION: A total of 681 studies were located; only four of these met the inclusion criteria and were analysed. The summary measure corresponding to the outcome adherence to treatment was 1·47 (95% confidence interval [CI]: 0·81-2·65), and the measure corresponding to the outcome virologic suppression was 1·95 (95% CI: 0·61-6·25). WHAT IS NEW AND CONCLUSION: The results suggest that pharmaceutical interventions might contribute to improved adherence to ART and the achievement of virologic suppression, although the differences between the intervention and control groups were not statistically significant. Pharmaceutical interventions might be more efficacious in populations with low adherence to treatment and greater vulnerability.

Factors associated with therapeutic success in HIV-positive individuals in southern Brazil.

WHAT IS KNOWN AND OBJECTIVE: Therapeutic success is characterized by undetectable viral load, immune reconstitution confirmed by CD4+ T-cell count and no clinical manifestations of disease. High treatment adherence is a major determinant of therapeutic success that needs prevention of viral replication, allowing immune reconstitution. Adherence to treatment <95% has been associated with both immune and viral failure. The objective of this study was to evaluate factors associated with therapeutic success in adult patients on highly active antiretroviral therapy (HAART) in a specialized centre for HIV-AIDS in southern Brazil, being defined therapeutic success as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥ 95%. METHODS: We conducted a historical cohort study nested in the PC-HIV randomized clinical trial of PC-HIV. We included adults who were on HAART at Pelotas HIV/AIDS Assistance Service between June 2006 and July 2007 and for whom information on treatment adherence, viral load and CD4+ cell count was available. Pregnant women were excluded. We obtained clinical data from medical records and socio-demographic information in an interview. Therapeutic success was defined as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥95%. RESULTS AND DISCUSSION: We included 136 patients (60% male) in the cohort study. Mean age was 40 ± 10 years, and median treatment duration was 59 months (IQR 25-93). Family income varied from 0 to 8 times the minimum wage (IQR 1·0-2·3). Therapeutic success was achieved by 90% (122 patients), and it was associated with previously undetectable viral load (PR = 1·30; 95% CI = 1·13-1·49) and treatment adherence prior to study entry (PR = 1·34; 95% CI = 1·07-1·69), independently of sex, age and previous immune status. WHAT IS NOW AND CONCLUSION: When undetectable viral load, CD4+ cell count ≥200 cells/mm(3) and treatment adherence above 95% are included in the definition of therapeutic success, the rate was elevated (90%) and the factors associated were previous history of adherence to HAART and previous undetectable viral load.

Transrectal bladder prolapse secondary to pelvic fracture in two dogs.

This report describes the exteriorisation of the urinary bladder in two dogs as a result of a laceration of the rectum from a traumatic pelvic fracture. Clinical examination and contrast radiography of the bladder were used as diagnostic tools. Both patients were treated with exploratory laparotomy, where traction of the bladder was utilised to pull the bladder through the traumatic rectal laceration allowing the organ to return to its normal anatomical position. This procedure was followed by surgical reconstruction of the rectum, resulting in effective resolution of each case.

Spatial and temporal distribution of benthic macroinvertebrates in a Southeastern Brazilian river.

Benthic macroinvertebrate assemblages are structured according to physical and chemical parameters that define microhabitats, including food supply, shelter to escape predators, and other biological parameters that influence reproductive success. The aim of this study is to investigate spatial and temporal distribution of macroinvertebrate assemblages at the Macaé river basin, in Rio de Janeiro state, Southeastern Brazil. According to the "Habitat Assessment Field Data Sheet--High Gradient Streams" (Barbour et al., 1999), the five sampling sites are considered as a reference condition. Despite the differences in hydrological parameters (mean width, depth and discharge) among sites, the physicochemical parameters and functional feeding groups' general structure were similar, except for the less impacted area, which showed more shredders. According to the Detrended Correspondence Analysis based on substrates, there is a clear distinction between pool and riffle assemblages. In fact, the riffle litter substrate had higher taxa in terms of richness and abundance, but the pool litter substrate had the greatest number of exclusive taxa. A Cluster Analysis based on sampling sites data showed that temporal variation was the main factor in structuring macroinvertebrate assemblages in the studied habitats.

Spatial and temporal distribution of benthic macroinvertebrates in a Southeastern Brazilian river

A fauna de macroinvertebrados bentônicos é estruturada por fatores físicos e químicos que determinam os microhábitats, incluindo a disponibilidade de alimento, a existência de refúgios contra predadores e tempestades, o sucesso reprodutivo e outros parâmetros biológicos. O objetivo deste estudo foi investigar a distribuição espaço-temporal da comunidade de macroinvertebrados bentônicos na bacia do rio Macaé, Estado do Rio de Janeiro, Brasil. De acordo com o Habitat Assessment Field Data Sheet – High Gradient Streams (Barbour et al., 1999), os cinco locais coletados são considerados como referência para propósito de biomonitoramento. Apesar das diferenças em parâmetros hidrográficos (largura, profundidade e vazão médias), os parâmetros físico-químicos e a composição dos grupos de alimentação funcional foram similares entre os locais, com exceção da área mais preservada, onde a porcentagem de organismos cortadores foi maior. De acordo com a Análise de Correspondência, há uma clara distinção entre áreas de remanso e de correnteza. De fato, o substrato folhiço de correnteza apresentou a fauna mais rica e abundante, enquanto o substrato folhiço de fundo apresentou o maior número de táxons exclusivos. A Análise de Agrupamento considerando os dados dos locais de coleta indicou que a variação temporal foi o fator mais importante na estruturação das comunidades nos hábitats estudados.

Application of biological measures for stream integrity assessment in south-east Brazil.

The sensitivity of eleven metrics using macroinvertebrate assemblages were evaluated in an environmental gradient in a tropical river in south-east Brazil. Eight sites were sampled in an altitudinal range of 160-650 m.a.s.l. during 1999 (April and August) and 2000 (February). Four substrates were sampled at each site: riffle litter, pool litter, stony substrates and sediment. Correspondence Analysis indicated that assemblages were primarily more influenced by physical changes (like deforestation and erosion processes) than the water chemistry. The sensitivity of each metric was evaluated through the application of box-and-whisker plot method by its power to assess impairment (metrics should be able to discriminate reference sites from impaired sites) and natural variability (metrics should not discriminate two reference sites). Metrics that failed in at least one of the above premises were not considered as sensitive. In this study, the most sensitive metrics were Shannon index, BMWP-ASPT, %_EPT, and relative abundance of EPT to Chironomidae.